Questions?

Treasurer Q&A

Question

What happens in a shared ministry situation where one Pastor is the minister of two congregations?

Answer

While we need to review each situation on a case by case basis, typically one congregation has the responsibility for payroll and then invoices the other congregation(s) for their portion based on the sharing agreement. Once the redesign is implemented, sharing agreements will have to address the sharing of the cost of the Green or Teal module.

Question

When is the pricing for each module coming out?

Answer

The premiums are currently being developed based on the claims experience of the past year. They will be released after the GSI Board approves the rates as in past years, in early November. Members will not be required to make their selection until the premiums are released.

Question

The spouse of our Pastor is also a Pastor in the ELCIC. The way the plan redesign reads is that one Pastor cannot opt out. Can you confirm this is the case please? It doesn’t make sense for a two Pastor family to have to each take a minimum package when one of them can have benefits for the family.

Answer

GSI is required to administer the plan in accordance with the insurance contract. This contract requires that there be no provision to waive coverage when the employer pays the premium as is the requirement in the National Compensation Guideline. The Guideline has been in place for a couple of years now and GSI is giving notice of this change to coincide with the redesign. Whether or not a redesign of the benefits was undertaken, the removal of the waiver must be implemented.

Most of the feedback that GSI received on the first version of the redesign was a deep concern for wanting the benefit costs to be shared equally. The concept is that ELCIC congregations and institutions share in the support for the health and wellness of all of those serving by providing a minimum level of benefits to all employees who meet the eligibility requirements.

Under the redesign, employers must at least provide eligible employees with the Blue module of the health and dental plan and an employee meeting eligibility cannot opt out. The Green and Teal modules may be selected by the employee with the premium difference paid either by the employee, the employer congregation or a combination of both.

If there is a spouse who is also employed within the ELCIC, then both employees must enroll in family coverage. With both spouses enrolled there will be more benefits available; in effect the coverage increases through co-ordination. For example, when one spouse makes a claim for the services of a chiropractor and pays the co-insurance or the claim exceeds a maximum, then the spouse’s account can pay towards the difference. In this way a working couple of the ELCIC will not be treated any differently than any working couple that does not work within an affiliated group.

With the design of the new modules, GSI is striving to address both the cost concerns of the congregations and the sustainability of the benefits plan.

Plan Member 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 fulfill 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 different modules in the health and dental plan?

Answer

Plan members have asked for flexibility to suit their health needs and goals. Also congregations have different levels of budgets and ability to finance a total compensation package.

Question

Am I able to change the module I initially have selected, at some later date?

Answer

A change in module selection can happen with a life event such as becoming a parent, a change in marital status, or a change in co-ordination of benefits (i.e. your Spouse either gains or losses their employment health benefit plan). All options are available for new selection with a life event, however the request must be made to GSI within 30 days of the event.

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.

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

Question

What is YMPE and how does it relate to the new benefits plan and eligibility?

Answer

YMPE stands for Yearly Maximum Pensionable Earnings and is set annually by Canada Revenue Agency. This is the limit of earnings on which contributions can be made to the Canada Pension Plan each year. GSI uses YMPE as a way to determine eligibility for the ELCIC pension and benefits plans. This marker was chosen as it is updated annually and set independently of GSI. Our policies require that employees earn at least 25% of YMPE for plan membership. This minimum threshold will remain the same when the redesign takes effect.

Question

How does housing allowance fit into the eligibility calculation?

Answer

GSI uses “Salary Basis” as a defined term to establish eligibility. Salary Basis includes base salary and housing allowance. We realize that clergy have the option to deduct the value of their residence from income to calculate income tax and Canada Pension Plan contributions.  This is unrelated to the ELCIC pension and benefits plans eligibility formula. GSI’s policies do not use taxable income for eligibility.  

Question

What is the eligibility for Non-Rostered employees?

Answer

The eligibility criteria for Non-Rostered employees is twofold:

  • working 20 hours per week, and
  • earning at least 25% YMPE.

The hours requirement is based on average hours throughout the year, as we recognize that there may be seasonal fluctuations.  The hours test will be eliminated January 1, 2021 with the redesign.

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 for the Blue module 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.

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 HSCA available will depend on whether you are enrolled in the Blue, Green or Teal module and whether you have single or family coverage. Please see the chart for a list of the amounts.

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.

ELCIC Group Benefits Plan Redesign 2021

The ELCIC Group Services Inc. Board of Directors would like to thank everyone who took time to participate in the health redesign survey and attend the consultations. Your engagement in the process and your thoughtful comments speak to the importance placed on being a part of the ELCIC Group Benefits Plan design review.

New Modular Design

The Board considered the survey results and comments, together with the discussions held at the consultations, and determined that changes could be made to the redesign in consideration of this feedback. These changes (i.e., a new modular design) will maintain the goal of adding flexibility, while mitigating the risk to the plan’s sustainability. The Board hopes the redesign will address concerns expressed on the initial redesign proposal.

The new design will offer three modules for selection: Blue, Green and Teal. A summary of coverages in each module is outlined in the chart below, and will be implemented on January 1, 2021.

Please review the information provided here to learn more about our ELCIC Group Benefits Plan Redesign for 2021.

Letter to Plan Members & Treasurers

Blue Green Teal Design Chart

Survey Results Report

Communication Archives

Redesign 2021 - Health Care Spending Account

Window on Benefits – Health Care Spending Account

Starting January 1, 2021, the ELCIC Group Benefits Plan will include a Health Care Spending Account (HCSA). An HCSA is a type of flexible coverage for plan members and can be used to pay for health and dental costs not covered in a plan. With the addition of an HCSA, plan members will have flexibility in how to spend their available funds.

When the changes to the ELCIC Group Benefits Plan take place in 2021, plan members’ full HCSA amount will be available at the start of the calendar year. Any unused HSCA dollars will be added to the next year’s HCSA balance and may be carried over for one year. Plan members will have 90 days to make a claim after year-end (March 31).

This coverage is new to the ELCIC plan and will bring flexibility and additional coverage for all plan members.

Wellness Benefit
The Teal module of coverage will also include a Lifestyle Spending Account (LSA) with a $500 credit. The LSA can be used for activities such as fitness memberships and childcare expenses. The amount claimed would be a taxable benefit and a statement sent to the Treasurer for adding to the year-end T4.

Response to Redesign 2021 - Consultation & Survey Feedback

Impact of the Consultations
In the fall of 2018, GSI announced that the ELCIC Group Benefits Plan would be undergoing a design change to take effect in 2021. After some members contacted the office with comments and questions, GSI thought it would be good to give everyone an opportunity to voice their concerns and provide suggestions in an informed way.

Survey and Feedback
To facilitate this, GSI sent an on-line survey to plan members and employers. GSI also hosted two in-person consultations with a live-stream option. Unfortunately, a planned third session had to be cancelled due to COVID-19 restrictions. Based on the feedback received directly by the GSI office, both from the survey and from the consultation discussions, GSI made some changes to the redesign originally put forward.

Here are some examples of how the redesign responds to the feedback from both plan members and employers.

Consultation & Survey Feedback

 

What we heard from members

 

 

GSI’s response

We are not comfortable with a design that requires an earnings test for increased coverage paid by the employer. All plan members should have equal access.

 

The minimum plan enrollment earnings test has remained (25% Yearly Maximum Pensionable Earnings), with the employer required to pay the premiums for the Blue module. There is no additional test for higher earnings to enroll in the Green or Teal modules or to require the employer to pay the premium difference. This allows for decisions to be made at the local level based on individual circumstances.
All members should have travel health coverage, including those over age 65.

 

All working plan members will have travel health coverage. The age restriction has been removed.
We constantly hit the maximum on coverage used. We need some flexibility to use the plan specifically where we need it.

 

A health care spending account is added to each module, and the Teal module has an additional wellness account. GSI will continue to consider opportunities for health improvement.
 

What we heard from employers

 

 

GSI’s response

Currently the congregations are paying 100% of the benefits premiums. Employees should be sharing in the costs.

 

While premiums for basic coverage in the Blue Module remain funded by the congregation, there is some cost sharing by plan members who use the plan via the co-pays. Plan members have the option improve the coverage, with reduced co-pays and higher health care spending accounts in the alternate modules. The premium difference can be paid by either the employer or the plan member (by payroll reduction).

 

The ELCIC Group Benefits Plan is very pricey and strains our ability to hire staff needed to support the ministry. Could we not pay half the premium for a half-time person?

 

Since the premium is tied to benefits provided, the premium cannot be halved without also reducing the coverage. GSI developed the Modular design in order to accommodate the various needs of the individual plan members and congregations.

 

Links to Consultation Sessions

We want to thank people who attended or watched the first two consultation sessions. If you were not able to join in any way, you are invited to watch the video of these sessions and send a message to info@elcicgsi.ca with any feedback, questions or concerns you might still have.

ABT Pastor’s Study Conference – Canmore AB (Feb 5th)

Christ Evangelical Church – Waterloo ON (Jan 25th)

Consultation Sessions for Changes to Group Benefits Plan

Last fall GSI announced that the ELCIC Group Benefits Plan will be undergoing a design change, to take effect in 2021. While we have been getting some feedback, we want to ensure that we have given everyone an opportunity to voice their concerns and provide suggestions in an informed way.

To do this, we are hosting three consultation sessions in the new year. Each session will be open to attend in person, as well as live streamed for those who cannot physically join us.

At these events we hope to provide you with clear rationale for why changes should be considered. We will include information about how the plan is used and what the costs are. We also want to hear from you – both the plan member and the representatives of the congregational councils.

If you are in the area, please join us.  We understand that geography might be a challenge so please consider the live stream option. We also encourage everyone to read the articles below in order to gain a full understanding of the changes being considered, and to help us make an informed decision.

Date Day and Time Location Live Stream
January 25, 2020 Saturday 11:30am

light lunch served

Christ Evangelical Church

445 Anndale Rd., Waterloo

The live stream link will be on the synod Facebook of our meeting location.

Find the ‘videos’ in the left menu and click on the link which will be available at the start of the session

February 5, 2020 Wednesday 1:30pm ABT Pastor’s Study Conference

Coast Canmore Hotel

511 Bow Valley Trail, Canmore

March 18, 2020 Wednesday 7:00pm Epiphany Lutheran Church

200 Dalhousie Dr., Winnipeg

(all times are local to the zone of the event)

Please continue to check this page for links to join the meetings via live stream.

Retiree Health Benefits - February 2020

Retiree Health Benefits

February 19, 2020

Last year GSI announced future changes to the structure of the ELCIC Group Benefits Plan, specifically the health program. Some retiree plan members expressed reservations about the changes and this prompted GSI to reconsider the redesign applicability to the retiree health program.

Based on this reassessment, rather than creating two streams of benefits for retirees, the retiree health program will continue with the single design format. Retiree plan members will not have to decide which stream they wish to choose.

The current retiree health plan design will remain in place with a couple of changes starting in January 2021. These will include moving to a Mandatory Generic Drug Plan as previously announced, but for the retiree health plan the co-pay on prescription drugs will be removed. As well, coverage for counselling (please review the approved list of counsellor designations) will be reduced to $2,500. The Summary of Benefits table on the back of this letter lists the benefits under the retiree health plan and shows the changes for 2021 in red.

We do not anticipate significant changes in premiums based on the changes listed in the table. No actions need to be taken to continue with your plan as a retiree.

To help us keep you informed, please contact the GSI office by phone or email and share with us your current email address.

 

Lisa Thiessen CPA CA

Executive Director

 

ELCIC Retiree Health Plan – Summary Benefits
Prescription Drugs
Description Current Plan update 2021
Drug Plan Name ManuScript Generic 2 Mandatory Generic Drug Plan (consistent with the changes previously announced)
Coverage 80% until out of pocket maximum of $250 is reached 100% thereafter 100%
Drug card Yes Yes
Deductible None None
Vision
Description Current Plan update 2021
Eye exams once every 24 months no proposed changes
Glasses/contacts $250 per 24 months
Deductible none
Paramedical
Description Current Plan update 2021
Professional services: acupuncturist, audiologist, chiropodist, chiropractor, dietitian, osteopath, podiatrist, massage therapist, naturopath, speech therapist each in list

$500 per calendar year

no proposed changes
Professional services:

Physiotherapist/ athletic therapist/ kinesiologist

combined

$500 per calendar year

no proposed changes
Professional services:

Psychologist/ clinical therapist, MFT, MSW or RSW, registered psychotherapist

combined

$5,000 per calendar year

combined

$2,500 per calendar year

Deductible none none
Medical Services and Supplies
Please see the website for a list of services and supplies covered under this benefit
There are no proposed changes to these benefits

Tough Talk about Health Plan Costs - Spring 2019

Tough Talk About Health Plan Costs

Spring 2019

Information in this document is provided with the hopes of bringing greater understanding regarding the financial background and considerations that have shaped the health plan redesign, which aims to benefit everyone in the future with a more sustainable benefits plan.

Cost Drivers in the Health Plan

The pharmacy benefit currently experiences both the greatest number of claims and the highest dollar value at around 70% of the ELCIC Group Benefits Plan extended healthcare premium. At a recent presentation by Manulife, the GSI board was updated regarding cost drivers and current and developing trends in prescription drug use.

Some factors such as generic drug reforms, increased generic utilization and patents expiring, are reducing drug costs. However, there are also more significant pressures forcing the costs upward. These include an aging population, increasing disease prevalence, and new specialty and higher cost drugs. Each year, new drugs are approved and added to the formulary of covered expenses in the ELCIC Benefits Plan. While a peek at the drugs currently in development — for previously untreatable conditions, or improvements for more effective treatment or elimination of side effects — is very exciting for the health management of Canadians, it is also very scary in terms of the accompanying costs of these advancements.

The trends highlighted in the Manulife presentation and a presentation by Mercer (GSI’s consultants) entitled “The Future of Healthcare”, and other conferences that members have attended, prompted the GSI board to take a hard look at the sustainability of the healthcare plan while maintaining the balance between the wellness of the plan members and the costs borne by the congregations.

Cost Sharing

Health plan cost sharing between the employer and plan member is the norm in Canada. There are typically two methods through which sharing takes place: splitting the premium payment, and/or through member co-pay when a claim is made. This co-pay can either be a percentage of the cost or a flat deductible. There could be any number of sharing formulas depending on how the premium is split or the co-pay per-cent is set.

Since health premiums are a benefit that is tax-free for the employee, it makes sense to have the employer pay some or all of the premium as part of the total compensation package. The Synodical Bishops and treasurers developed a harmonized compensation guideline (approved by National Church Council September 2016), which specified that employers would pay 100% of the health and dental premiums.

Prior to the harmonization, the majority of Synods had a premium split formula. This change left GSI to determine an appropriate and reasonable co-pay formula to balance the cost sharing. After careful review of the market and the options, it was decided that with the 2021 redesign, GSI would amend the co-pay formula from the current 20% (paid by the member) to 30% for the Enhanced stream and 40% for the Core stream.

Enhanced and Core Pricing

The Enhanced plan is priced on a premium cost neutral basis. The change in the co-pay will actually fund the new health care spending account. This decision was made based on the 2018 plan member survey where members asked for more flexibility.

The Core plan is designed to support a premium at 60% of the Enhanced plan. The Core plan is a move towards affordability and therefore sustainability of the health plan.

Financial Efficiencies

GSI continually reviews the financial results of each distinct benefit within the group plan. The GSI board ensures that the expenses to manage each benefit remain cost effective. This is done by allocating appropriate overhead costs, while reviewing the reasonableness of all expenses and adjusting budgets for the level of plan membership.

The question has arisen from time to time of whether cost efficiencies will continue to be achieved as the enrollment declines. GSI has estimated an attrition rate of about 5% a year in plan membership decline. While predictions are always based on some unknowns, at this time GSI believes it can continue to balance the costs on a per member basis. GSI regularly analyzes statistical and financial results and is fairly nimble in its decision making as it makes choices towards a sustainable plan.

Further to the question of efficiencies, some suggest that a solution may be to explore joining another group benefits plan. This option is not financially supported as >95% of the cost relates to claims and <5% relates to administration of the plan sponsor. In order to join another group for financial benefit, that group would have to have better claim experience (e.g. by having many younger, healthy members) to reduce the premium on the same plan design. There would be little motivation for such a group to join with ELCIC and risk an increase to their premiums.

Governance

GSI as plan sponsor remains committed to offering a competitive benefits plan to support plan members in strengthening their physical, mental and financial health today and into the future, in a format sustainable for the congregations/employers of the ELCIC.

 

Lisa Thiessen CPA CA

Executive Director

Medical Professionals & Medical Supplies and Services - September 2019

Professional Services 

This month, we are highlighting Professional Services for the Health & Dental Redesign beginning January 2021.

The list of practitioners that provide the Professional Services remains unchanged in the redesign. These services will require a co-pay consistent with the prescription drug plan.

The co-pay element in the redesign will help make a shift to longer-term wellness strategy by stretching out the coverage, which could benefit more plan members with chronic illness.

 

 

Professional Services

 

Current plan Enhanced plan Core plan
Professional Services: acupuncturist, audiologist, chiropodist, chiropractor, dietitian, osteopath, podiatrist, massage therapist, naturopath, speech therapist,  

$500/year

 

$500/year

 

$300/year

Physiotherapist, athletic therapist, kinesiologist (in combination)

 

 

$500/year

 

$500/year

 

$300/year

Psychologist, marriage and family therapist, masters in social work, registered social worker (in combination)  

$5000/year

 

$5000/year

 

$3000/year

Co-pay 100% 70% 60%
Deductible None None none

 

 

 

Medical Services and Supplies

 

Current plan Enhanced plan Core plan
Nursing, ambulance, insulin pumps (50%), mobility equipment, hearing aids, orthopedic shoes, oxygen etc.

(note no hospital coverage)

 

 

Maximums by Items

 

 

Maximums by Items

(no change)

 

 

Maximums by Items

(no change)

 

Co-pay 100% 100% 100%
Deductible None None none

Prescription Drug Benefits Redesign Details - June 2019

Prescription Drugs 

Prescription drugs will continue to be a significant and important part of the benefits plan when the new health care design takes effect in January 2021. 

 

Coverage amounts will be based on two streams – Enhanced and Core. The Enhanced stream will provide coverage of 70% of the prescription cost covered, while the Core stream will cover 60%. Plan members will continue to have the convenience of a drug card that can be used at any pharmacy.  

 

The Manulife Mandatory Generic Drug plan will also come into effect in January 2021 and will provide a coverage amount equal to the lowest cost available for the drug prescribed.   

 

The newly created Health Care Spending Account can be used toward any prescription costs not covered in the plan design or any other healthcare costs that exceed the plan’s maximum coverage.  

 

The Manulife App will be available to members in both the Enhanced and Core streams to help keep track of their prescription claims. Plan members will be able to receive an email informing them that a claim was submitted on their behalf by their pharmacist. They will then be able to review the claim details on the plan member site. 

 

 

Table Comparison 

This table outlines a comparison of the current prescription drug plan to the new design, beginning January of 2021.   

 

  Current Plan  Enhanced Plan (2021)  Core Plan (2021) 
       
  Deductible  None  None  None 
  Reimbursement  80% until out of pocket max is reached – 100% thereafter  70%  60% 
  Out of Pocket Max  $250  None  None 
  Plan  ManuScript Generic Drug Card Plan 2  Mandatory Generic Drug Plan (Drug Card)  Mandatory Generic Drug Plan (Drug Card) 
  Maximum  $1,000,000 per calendar year  $1,000,000 per calendar year  $1,000,000 per calendar year 

 

 

Improvements to Drug Plan Over the Years 

The prescription drug benefit has seen many improvements over the years. New drugs are constantly being approved and added to the plan. 

 

The Specialty Drug Care Program began in 2015 and includes a preferred pharmacy network, pharmacy services, preferred pricing and case management servicesSpecialty Drugs are highcost medications used to treat complex chronic and life-threatening conditions and may require special storage, handling and administration, (including injection and infusion), and involve a significant degree of patient education, monitoring and management. We have been happy to include this unique benefit for plan members since 2015 and will continue to provide this in the redesigned plan.

Dental Benefits Redesign Details - March 2019

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

Health Care Spending Account - January 2019

Health & Dental Redesign 2021 – Health Care Spending Account

As announced last year, the GSI Board will be making some changes to the structure of the ELCIC Health and Dental plan. In the coming year, we will be outlining all the details of the new coverage for you in our newsletter.

This month, we are taking a closer look at the Health Care Spending Account (HCSA). This will be a new addition to coverage in both the Core and Enhanced streams.

Health Care Spending Account
An HCSA is a type of supplemental coverage for plan members and can be used to pay for health and dental costs not covered in a plan. With the addition of an HCSA, plan members will have flexibility in how to spend their available funds.

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.

When the changes to the Health & Dental Plan take place in 2021, plan members’ full 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 and may be carried over for one year. The annual amount will be determined closer to implementation date, with amounts varying, depending on the member’s plan.

Summary of Redesign to Health & Dental Benefits - December 2018

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. 

Introducing Health & Dental Plan Redesign - October 2018

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

Redesign 2021 - Health Care Spending Account

Window on Benefits – Health Care Spending Account

Starting January 1, 2021, the ELCIC Group Benefits Plan will include a Health Care Spending Account (HCSA). An HCSA is a type of flexible coverage for plan members and can be used to pay for health and dental costs not covered in a plan. With the addition of an HCSA, plan members will have flexibility in how to spend their available funds.

When the changes to the ELCIC Group Benefits Plan take place in 2021, plan members’ full HCSA amount will be available at the start of the calendar year. Any unused HSCA dollars will be added to the next year’s HCSA balance and may be carried over for one year. Plan members will have 90 days to make a claim after year-end (March 31).

This coverage is new to the ELCIC plan and will bring flexibility and additional coverage for all plan members.

Wellness Benefit
The Teal module of coverage will also include a Lifestyle Spending Account (LSA) with a $500 credit. The LSA can be used for activities such as fitness memberships and childcare expenses. The amount claimed would be a taxable benefit and a statement sent to the Treasurer for adding to the year-end T4.

Response to Redesign 2021 - Consultation & Survey Feedback

Impact of the Consultations
In the fall of 2018, GSI announced that the ELCIC Group Benefits Plan would be undergoing a design change to take effect in 2021. After some members contacted the office with comments and questions, GSI thought it would be good to give everyone an opportunity to voice their concerns and provide suggestions in an informed way.

Survey and Feedback
To facilitate this, GSI sent an on-line survey to plan members and employers. GSI also hosted two in-person consultations with a live-stream option. Unfortunately, a planned third session had to be cancelled due to COVID-19 restrictions. Based on the feedback received directly by the GSI office, both from the survey and from the consultation discussions, GSI made some changes to the redesign originally put forward.

Here are some examples of how the redesign responds to the feedback from both plan members and employers.

Consultation & Survey Feedback

 

What we heard from members

 

 

GSI’s response

We are not comfortable with a design that requires an earnings test for increased coverage paid by the employer. All plan members should have equal access.

 

The minimum plan enrollment earnings test has remained (25% Yearly Maximum Pensionable Earnings), with the employer required to pay the premiums for the Blue module. There is no additional test for higher earnings to enroll in the Green or Teal modules or to require the employer to pay the premium difference. This allows for decisions to be made at the local level based on individual circumstances.
All members should have travel health coverage, including those over age 65.

 

All working plan members will have travel health coverage. The age restriction has been removed.
We constantly hit the maximum on coverage used. We need some flexibility to use the plan specifically where we need it.

 

A health care spending account is added to each module, and the Teal module has an additional wellness account. GSI will continue to consider opportunities for health improvement.
 

What we heard from employers

 

 

GSI’s response

Currently the congregations are paying 100% of the benefits premiums. Employees should be sharing in the costs.

 

While premiums for basic coverage in the Blue Module remain funded by the congregation, there is some cost sharing by plan members who use the plan via the co-pays. Plan members have the option improve the coverage, with reduced co-pays and higher health care spending accounts in the alternate modules. The premium difference can be paid by either the employer or the plan member (by payroll reduction).

 

The ELCIC Group Benefits Plan is very pricey and strains our ability to hire staff needed to support the ministry. Could we not pay half the premium for a half-time person?

 

Since the premium is tied to benefits provided, the premium cannot be halved without also reducing the coverage. GSI developed the Modular design in order to accommodate the various needs of the individual plan members and congregations.

 

Links to Consultation Sessions

We want to thank people who attended or watched the first two consultation sessions. If you were not able to join in any way, you are invited to watch the video of these sessions and send a message to info@elcicgsi.ca with any feedback, questions or concerns you might still have.

ABT Pastor’s Study Conference – Canmore AB (Feb 5th)

Christ Evangelical Church – Waterloo ON (Jan 25th)

Consultation Sessions for Changes to Group Benefits Plan

Last fall GSI announced that the ELCIC Group Benefits Plan will be undergoing a design change, to take effect in 2021. While we have been getting some feedback, we want to ensure that we have given everyone an opportunity to voice their concerns and provide suggestions in an informed way.

To do this, we are hosting three consultation sessions in the new year. Each session will be open to attend in person, as well as live streamed for those who cannot physically join us.

At these events we hope to provide you with clear rationale for why changes should be considered. We will include information about how the plan is used and what the costs are. We also want to hear from you – both the plan member and the representatives of the congregational councils.

If you are in the area, please join us.  We understand that geography might be a challenge so please consider the live stream option. We also encourage everyone to read the articles below in order to gain a full understanding of the changes being considered, and to help us make an informed decision.

Date Day and Time Location Live Stream
January 25, 2020 Saturday 11:30am

light lunch served

Christ Evangelical Church

445 Anndale Rd., Waterloo

The live stream link will be on the synod Facebook of our meeting location.

Find the ‘videos’ in the left menu and click on the link which will be available at the start of the session

February 5, 2020 Wednesday 1:30pm ABT Pastor’s Study Conference

Coast Canmore Hotel

511 Bow Valley Trail, Canmore

March 18, 2020 Wednesday 7:00pm Epiphany Lutheran Church

200 Dalhousie Dr., Winnipeg

(all times are local to the zone of the event)

Please continue to check this page for links to join the meetings via live stream.

Retiree Health Benefits - February 2020

Retiree Health Benefits

February 19, 2020

Last year GSI announced future changes to the structure of the ELCIC Group Benefits Plan, specifically the health program. Some retiree plan members expressed reservations about the changes and this prompted GSI to reconsider the redesign applicability to the retiree health program.

Based on this reassessment, rather than creating two streams of benefits for retirees, the retiree health program will continue with the single design format. Retiree plan members will not have to decide which stream they wish to choose.

The current retiree health plan design will remain in place with a couple of changes starting in January 2021. These will include moving to a Mandatory Generic Drug Plan as previously announced, but for the retiree health plan the co-pay on prescription drugs will be removed. As well, coverage for counselling (please review the approved list of counsellor designations) will be reduced to $2,500. The Summary of Benefits table on the back of this letter lists the benefits under the retiree health plan and shows the changes for 2021 in red.

We do not anticipate significant changes in premiums based on the changes listed in the table. No actions need to be taken to continue with your plan as a retiree.

To help us keep you informed, please contact the GSI office by phone or email and share with us your current email address.

 

Lisa Thiessen CPA CA

Executive Director

 

ELCIC Retiree Health Plan – Summary Benefits
Prescription Drugs
Description Current Plan update 2021
Drug Plan Name ManuScript Generic 2 Mandatory Generic Drug Plan (consistent with the changes previously announced)
Coverage 80% until out of pocket maximum of $250 is reached 100% thereafter 100%
Drug card Yes Yes
Deductible None None
Vision
Description Current Plan update 2021
Eye exams once every 24 months no proposed changes
Glasses/contacts $250 per 24 months
Deductible none
Paramedical
Description Current Plan update 2021
Professional services: acupuncturist, audiologist, chiropodist, chiropractor, dietitian, osteopath, podiatrist, massage therapist, naturopath, speech therapist each in list

$500 per calendar year

no proposed changes
Professional services:

Physiotherapist/ athletic therapist/ kinesiologist

combined

$500 per calendar year

no proposed changes
Professional services:

Psychologist/ clinical therapist, MFT, MSW or RSW, registered psychotherapist

combined

$5,000 per calendar year

combined

$2,500 per calendar year

Deductible none none
Medical Services and Supplies
Please see the website for a list of services and supplies covered under this benefit
There are no proposed changes to these benefits

Tough Talk about Health Plan Costs - Spring 2019

Tough Talk About Health Plan Costs

Spring 2019

Information in this document is provided with the hopes of bringing greater understanding regarding the financial background and considerations that have shaped the health plan redesign, which aims to benefit everyone in the future with a more sustainable benefits plan.

Cost Drivers in the Health Plan

The pharmacy benefit currently experiences both the greatest number of claims and the highest dollar value at around 70% of the ELCIC Group Benefits Plan extended healthcare premium. At a recent presentation by Manulife, the GSI board was updated regarding cost drivers and current and developing trends in prescription drug use.

Some factors such as generic drug reforms, increased generic utilization and patents expiring, are reducing drug costs. However, there are also more significant pressures forcing the costs upward. These include an aging population, increasing disease prevalence, and new specialty and higher cost drugs. Each year, new drugs are approved and added to the formulary of covered expenses in the ELCIC Benefits Plan. While a peek at the drugs currently in development — for previously untreatable conditions, or improvements for more effective treatment or elimination of side effects — is very exciting for the health management of Canadians, it is also very scary in terms of the accompanying costs of these advancements.

The trends highlighted in the Manulife presentation and a presentation by Mercer (GSI’s consultants) entitled “The Future of Healthcare”, and other conferences that members have attended, prompted the GSI board to take a hard look at the sustainability of the healthcare plan while maintaining the balance between the wellness of the plan members and the costs borne by the congregations.

Cost Sharing

Health plan cost sharing between the employer and plan member is the norm in Canada. There are typically two methods through which sharing takes place: splitting the premium payment, and/or through member co-pay when a claim is made. This co-pay can either be a percentage of the cost or a flat deductible. There could be any number of sharing formulas depending on how the premium is split or the co-pay per-cent is set.

Since health premiums are a benefit that is tax-free for the employee, it makes sense to have the employer pay some or all of the premium as part of the total compensation package. The Synodical Bishops and treasurers developed a harmonized compensation guideline (approved by National Church Council September 2016), which specified that employers would pay 100% of the health and dental premiums.

Prior to the harmonization, the majority of Synods had a premium split formula. This change left GSI to determine an appropriate and reasonable co-pay formula to balance the cost sharing. After careful review of the market and the options, it was decided that with the 2021 redesign, GSI would amend the co-pay formula from the current 20% (paid by the member) to 30% for the Enhanced stream and 40% for the Core stream.

Enhanced and Core Pricing

The Enhanced plan is priced on a premium cost neutral basis. The change in the co-pay will actually fund the new health care spending account. This decision was made based on the 2018 plan member survey where members asked for more flexibility.

The Core plan is designed to support a premium at 60% of the Enhanced plan. The Core plan is a move towards affordability and therefore sustainability of the health plan.

Financial Efficiencies

GSI continually reviews the financial results of each distinct benefit within the group plan. The GSI board ensures that the expenses to manage each benefit remain cost effective. This is done by allocating appropriate overhead costs, while reviewing the reasonableness of all expenses and adjusting budgets for the level of plan membership.

The question has arisen from time to time of whether cost efficiencies will continue to be achieved as the enrollment declines. GSI has estimated an attrition rate of about 5% a year in plan membership decline. While predictions are always based on some unknowns, at this time GSI believes it can continue to balance the costs on a per member basis. GSI regularly analyzes statistical and financial results and is fairly nimble in its decision making as it makes choices towards a sustainable plan.

Further to the question of efficiencies, some suggest that a solution may be to explore joining another group benefits plan. This option is not financially supported as >95% of the cost relates to claims and <5% relates to administration of the plan sponsor. In order to join another group for financial benefit, that group would have to have better claim experience (e.g. by having many younger, healthy members) to reduce the premium on the same plan design. There would be little motivation for such a group to join with ELCIC and risk an increase to their premiums.

Governance

GSI as plan sponsor remains committed to offering a competitive benefits plan to support plan members in strengthening their physical, mental and financial health today and into the future, in a format sustainable for the congregations/employers of the ELCIC.

 

Lisa Thiessen CPA CA

Executive Director

Medical Professionals & Medical Supplies and Services - September 2019

Professional Services 

This month, we are highlighting Professional Services for the Health & Dental Redesign beginning January 2021.

The list of practitioners that provide the Professional Services remains unchanged in the redesign. These services will require a co-pay consistent with the prescription drug plan.

The co-pay element in the redesign will help make a shift to longer-term wellness strategy by stretching out the coverage, which could benefit more plan members with chronic illness.

 

 

Professional Services

 

Current plan Enhanced plan Core plan
Professional Services: acupuncturist, audiologist, chiropodist, chiropractor, dietitian, osteopath, podiatrist, massage therapist, naturopath, speech therapist,  

$500/year

 

$500/year

 

$300/year

Physiotherapist, athletic therapist, kinesiologist (in combination)

 

 

$500/year

 

$500/year

 

$300/year

Psychologist, marriage and family therapist, masters in social work, registered social worker (in combination)  

$5000/year

 

$5000/year

 

$3000/year

Co-pay 100% 70% 60%
Deductible None None none

 

 

 

Medical Services and Supplies

 

Current plan Enhanced plan Core plan
Nursing, ambulance, insulin pumps (50%), mobility equipment, hearing aids, orthopedic shoes, oxygen etc.

(note no hospital coverage)

 

 

Maximums by Items

 

 

Maximums by Items

(no change)

 

 

Maximums by Items

(no change)

 

Co-pay 100% 100% 100%
Deductible None None none

Prescription Drug Benefits Redesign Details - June 2019

Prescription Drugs 

Prescription drugs will continue to be a significant and important part of the benefits plan when the new health care design takes effect in January 2021. 

 

Coverage amounts will be based on two streams – Enhanced and Core. The Enhanced stream will provide coverage of 70% of the prescription cost covered, while the Core stream will cover 60%. Plan members will continue to have the convenience of a drug card that can be used at any pharmacy.  

 

The Manulife Mandatory Generic Drug plan will also come into effect in January 2021 and will provide a coverage amount equal to the lowest cost available for the drug prescribed.   

 

The newly created Health Care Spending Account can be used toward any prescription costs not covered in the plan design or any other healthcare costs that exceed the plan’s maximum coverage.  

 

The Manulife App will be available to members in both the Enhanced and Core streams to help keep track of their prescription claims. Plan members will be able to receive an email informing them that a claim was submitted on their behalf by their pharmacist. They will then be able to review the claim details on the plan member site. 

 

 

Table Comparison 

This table outlines a comparison of the current prescription drug plan to the new design, beginning January of 2021.   

 

  Current Plan  Enhanced Plan (2021)  Core Plan (2021) 
       
  Deductible  None  None  None 
  Reimbursement  80% until out of pocket max is reached – 100% thereafter  70%  60% 
  Out of Pocket Max  $250  None  None 
  Plan  ManuScript Generic Drug Card Plan 2  Mandatory Generic Drug Plan (Drug Card)  Mandatory Generic Drug Plan (Drug Card) 
  Maximum  $1,000,000 per calendar year  $1,000,000 per calendar year  $1,000,000 per calendar year 

 

 

Improvements to Drug Plan Over the Years 

The prescription drug benefit has seen many improvements over the years. New drugs are constantly being approved and added to the plan. 

 

The Specialty Drug Care Program began in 2015 and includes a preferred pharmacy network, pharmacy services, preferred pricing and case management servicesSpecialty Drugs are highcost medications used to treat complex chronic and life-threatening conditions and may require special storage, handling and administration, (including injection and infusion), and involve a significant degree of patient education, monitoring and management. We have been happy to include this unique benefit for plan members since 2015 and will continue to provide this in the redesigned plan.

Dental Benefits Redesign Details - March 2019

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

Health Care Spending Account - January 2019

Health & Dental Redesign 2021 – Health Care Spending Account

As announced last year, the GSI Board will be making some changes to the structure of the ELCIC Health and Dental plan. In the coming year, we will be outlining all the details of the new coverage for you in our newsletter.

This month, we are taking a closer look at the Health Care Spending Account (HCSA). This will be a new addition to coverage in both the Core and Enhanced streams.

Health Care Spending Account
An HCSA is a type of supplemental coverage for plan members and can be used to pay for health and dental costs not covered in a plan. With the addition of an HCSA, plan members will have flexibility in how to spend their available funds.

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.

When the changes to the Health & Dental Plan take place in 2021, plan members’ full 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 and may be carried over for one year. The annual amount will be determined closer to implementation date, with amounts varying, depending on the member’s plan.

Summary of Redesign to Health & Dental Benefits - December 2018

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. 

Introducing Health & Dental Plan Redesign - October 2018

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

Consultation Sessions for Changes to Group Benefits Plan

Last fall GSI announced that the ELCIC Group Benefits Plan will be undergoing a design change, to take effect in 2021. While we have been getting some feedback, we want to ensure that we have given everyone an opportunity to voice their concerns and provide suggestions in an informed way.

To do this, we are hosting three consultation sessions in the new year. Each session will be open to attend in person, as well as live streamed for those who cannot physically join us.

At these events we hope to provide you with clear rationale for why changes should be considered. We will include information about how the plan is used and what the costs are. We also want to hear from you – both the plan member and the representatives of the congregational councils.

If you are in the area, please join us.  We understand that geography might be a challenge so please consider the live stream option. We also encourage everyone to read the articles below in order to gain a full understanding of the changes being considered, and to help us make an informed decision.

Date Day and Time Location Live Stream
January 25, 2020 Saturday 11:30am

light lunch served

Christ Evangelical Church

445 Anndale Rd., Waterloo

The live stream link will be on the synod Facebook of our meeting location.

Find the ‘videos’ in the left menu and click on the link which will be available at the start of the session

February 5, 2020 Wednesday 1:30pm ABT Pastor’s Study Conference

Coast Canmore Hotel

511 Bow Valley Trail, Canmore

March 18, 2020 Wednesday 7:00pm Epiphany Lutheran Church

200 Dalhousie Dr., Winnipeg

(all times are local to the zone of the event)

Please continue to check this page for links to join the meetings via live stream.

Retiree Health Benefits - February 2019

Retiree Health Benefits

February 19, 2020

Last year GSI announced future changes to the structure of the ELCIC Group Benefits Plan, specifically the health program. Some retiree plan members expressed reservations about the changes and this prompted GSI to reconsider the redesign applicability to the retiree health program.

Based on this reassessment, rather than creating two streams of benefits for retirees, the retiree health program will continue with the single design format. Retiree plan members will not have to decide which stream they wish to choose.

The current retiree health plan design will remain in place with a couple of changes starting in January 2021. These will include moving to a Mandatory Generic Drug Plan as previously announced, but for the retiree health plan the co-pay on prescription drugs will be removed. As well, coverage for counselling (please review the approved list of counsellor designations) will be reduced to $2,500. The Summary of Benefits table on the back of this letter lists the benefits under the retiree health plan and shows the changes for 2021 in red.

We do not anticipate significant changes in premiums based on the changes listed in the table. No actions need to be taken to continue with your plan as a retiree.

To help us keep you informed, please contact the GSI office by phone or email and share with us your current email address.

 

Lisa Thiessen CPA CA

Executive Director

 

ELCIC Retiree Health Plan – Summary Benefits
Prescription Drugs
Description Current Plan update 2021
Drug Plan Name ManuScript Generic 2 Mandatory Generic Drug Plan (consistent with the changes previously announced)
Coverage 80% until out of pocket maximum of $250 is reached 100% thereafter 100%
Drug card Yes Yes
Deductible None None
Vision
Description Current Plan update 2021
Eye exams once every 24 months no proposed changes
Glasses/contacts $250 per 24 months
Deductible none
Paramedical
Description Current Plan update 2021
Professional services: acupuncturist, audiologist, chiropodist, chiropractor, dietitian, osteopath, podiatrist, massage therapist, naturopath, speech therapist each in list

$500 per calendar year

no proposed changes
Professional services:

Physiotherapist/ athletic therapist/ kinesiologist

combined

$500 per calendar year

no proposed changes
Professional services:

Psychologist/ clinical therapist, MFT, MSW or RSW, registered psychotherapist

combined

$5,000 per calendar year

combined

$2,500 per calendar year

Deductible none none
Medical Services and Supplies
Please see the website for a list of services and supplies covered under this benefit
There are no proposed changes to these benefits

Tough Talk about Health Plan Costs - Spring 2019

Tough Talk About Health Plan Costs

Spring 2019

Information in this document is provided with the hopes of bringing greater understanding regarding the financial background and considerations that have shaped the health plan redesign, which aims to benefit everyone in the future with a more sustainable benefits plan.

Cost Drivers in the Health Plan

The pharmacy benefit currently experiences both the greatest number of claims and the highest dollar value at around 70% of the ELCIC Group Benefits Plan extended healthcare premium. At a recent presentation by Manulife, the GSI board was updated regarding cost drivers and current and developing trends in prescription drug use.

Some factors such as generic drug reforms, increased generic utilization and patents expiring, are reducing drug costs. However, there are also more significant pressures forcing the costs upward. These include an aging population, increasing disease prevalence, and new specialty and higher cost drugs. Each year, new drugs are approved and added to the formulary of covered expenses in the ELCIC Benefits Plan. While a peek at the drugs currently in development — for previously untreatable conditions, or improvements for more effective treatment or elimination of side effects — is very exciting for the health management of Canadians, it is also very scary in terms of the accompanying costs of these advancements.

The trends highlighted in the Manulife presentation and a presentation by Mercer (GSI’s consultants) entitled “The Future of Healthcare”, and other conferences that members have attended, prompted the GSI board to take a hard look at the sustainability of the healthcare plan while maintaining the balance between the wellness of the plan members and the costs borne by the congregations.

Cost Sharing

Health plan cost sharing between the employer and plan member is the norm in Canada. There are typically two methods through which sharing takes place: splitting the premium payment, and/or through member co-pay when a claim is made. This co-pay can either be a percentage of the cost or a flat deductible. There could be any number of sharing formulas depending on how the premium is split or the co-pay per-cent is set.

Since health premiums are a benefit that is tax-free for the employee, it makes sense to have the employer pay some or all of the premium as part of the total compensation package. The Synodical Bishops and treasurers developed a harmonized compensation guideline (approved by National Church Council September 2016), which specified that employers would pay 100% of the health and dental premiums.

Prior to the harmonization, the majority of Synods had a premium split formula. This change left GSI to determine an appropriate and reasonable co-pay formula to balance the cost sharing. After careful review of the market and the options, it was decided that with the 2021 redesign, GSI would amend the co-pay formula from the current 20% (paid by the member) to 30% for the Enhanced stream and 40% for the Core stream.

Enhanced and Core Pricing

The Enhanced plan is priced on a premium cost neutral basis. The change in the co-pay will actually fund the new health care spending account. This decision was made based on the 2018 plan member survey where members asked for more flexibility.

The Core plan is designed to support a premium at 60% of the Enhanced plan. The Core plan is a move towards affordability and therefore sustainability of the health plan.

Financial Efficiencies

GSI continually reviews the financial results of each distinct benefit within the group plan. The GSI board ensures that the expenses to manage each benefit remain cost effective. This is done by allocating appropriate overhead costs, while reviewing the reasonableness of all expenses and adjusting budgets for the level of plan membership.

The question has arisen from time to time of whether cost efficiencies will continue to be achieved as the enrollment declines. GSI has estimated an attrition rate of about 5% a year in plan membership decline. While predictions are always based on some unknowns, at this time GSI believes it can continue to balance the costs on a per member basis. GSI regularly analyzes statistical and financial results and is fairly nimble in its decision making as it makes choices towards a sustainable plan.

Further to the question of efficiencies, some suggest that a solution may be to explore joining another group benefits plan. This option is not financially supported as >95% of the cost relates to claims and <5% relates to administration of the plan sponsor. In order to join another group for financial benefit, that group would have to have better claim experience (e.g. by having many younger, healthy members) to reduce the premium on the same plan design. There would be little motivation for such a group to join with ELCIC and risk an increase to their premiums.

Governance

GSI as plan sponsor remains committed to offering a competitive benefits plan to support plan members in strengthening their physical, mental and financial health today and into the future, in a format sustainable for the congregations/employers of the ELCIC.

 

Lisa Thiessen CPA CA

Executive Director

Medical Professionals & Medical Supplies and Services - September 2019

Professional Services 

This month, we are highlighting Professional Services for the Health & Dental Redesign beginning January 2021.

The list of practitioners that provide the Professional Services remains unchanged in the redesign. These services will require a co-pay consistent with the prescription drug plan.

The co-pay element in the redesign will help make a shift to longer-term wellness strategy by stretching out the coverage, which could benefit more plan members with chronic illness.

 

 

Professional Services

 

Current plan Enhanced plan Core plan
Professional Services: acupuncturist, audiologist, chiropodist, chiropractor, dietitian, osteopath, podiatrist, massage therapist, naturopath, speech therapist,  

$500/year

 

$500/year

 

$300/year

Physiotherapist, athletic therapist, kinesiologist (in combination)

 

 

$500/year

 

$500/year

 

$300/year

Psychologist, marriage and family therapist, masters in social work, registered social worker (in combination)  

$5000/year

 

$5000/year

 

$3000/year

Co-pay 100% 70% 60%
Deductible None None none

 

 

 

Medical Services and Supplies

 

Current plan Enhanced plan Core plan
Nursing, ambulance, insulin pumps (50%), mobility equipment, hearing aids, orthopedic shoes, oxygen etc.

(note no hospital coverage)

 

 

Maximums by Items

 

 

Maximums by Items

(no change)

 

 

Maximums by Items

(no change)

 

Co-pay 100% 100% 100%
Deductible None None none

Prescription Drug Benefits Redesign Details - June 2019

Prescription Drugs 

Prescription drugs will continue to be a significant and important part of the benefits plan when the new health care design takes effect in January 2021. 

 

Coverage amounts will be based on two streams – Enhanced and Core. The Enhanced stream will provide coverage of 70% of the prescription cost covered, while the Core stream will cover 60%. Plan members will continue to have the convenience of a drug card that can be used at any pharmacy.  

 

The Manulife Mandatory Generic Drug plan will also come into effect in January 2021 and will provide a coverage amount equal to the lowest cost available for the drug prescribed.   

 

The newly created Health Care Spending Account can be used toward any prescription costs not covered in the plan design or any other healthcare costs that exceed the plan’s maximum coverage.  

 

The Manulife App will be available to members in both the Enhanced and Core streams to help keep track of their prescription claims. Plan members will be able to receive an email informing them that a claim was submitted on their behalf by their pharmacist. They will then be able to review the claim details on the plan member site. 

 

 

Table Comparison 

This table outlines a comparison of the current prescription drug plan to the new design, beginning January of 2021.   

 

  Current Plan  Enhanced Plan (2021)  Core Plan (2021) 
       
  Deductible  None  None  None 
  Reimbursement  80% until out of pocket max is reached – 100% thereafter  70%  60% 
  Out of Pocket Max  $250  None  None 
  Plan  ManuScript Generic Drug Card Plan 2  Mandatory Generic Drug Plan (Drug Card)  Mandatory Generic Drug Plan (Drug Card) 
  Maximum  $1,000,000 per calendar year  $1,000,000 per calendar year  $1,000,000 per calendar year 

 

 

Improvements to Drug Plan Over the Years 

The prescription drug benefit has seen many improvements over the years. New drugs are constantly being approved and added to the plan. 

 

The Specialty Drug Care Program began in 2015 and includes a preferred pharmacy network, pharmacy services, preferred pricing and case management servicesSpecialty Drugs are highcost medications used to treat complex chronic and life-threatening conditions and may require special storage, handling and administration, (including injection and infusion), and involve a significant degree of patient education, monitoring and management. We have been happy to include this unique benefit for plan members since 2015 and will continue to provide this in the redesigned plan.

Dental Benefits Redesign Details - March 2019

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

Health Care Spending Account - January 2019

Health & Dental Redesign 2021 – Health Care Spending Account

As announced last year, the GSI Board will be making some changes to the structure of the ELCIC Health and Dental plan. In the coming year, we will be outlining all the details of the new coverage for you in our newsletter.

This month, we are taking a closer look at the Health Care Spending Account (HCSA). This will be a new addition to coverage in both the Core and Enhanced streams.

Health Care Spending Account
An HCSA is a type of supplemental coverage for plan members and can be used to pay for health and dental costs not covered in a plan. With the addition of an HCSA, plan members will have flexibility in how to spend their available funds.

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.

When the changes to the Health & Dental Plan take place in 2021, plan members’ full 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 and may be carried over for one year. The annual amount will be determined closer to implementation date, with amounts varying, depending on the member’s plan.

Summary of Redesign to Health & Dental Benefits - December 2018

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. 

Introducing Health & Dental Plan Redesign - October 2018

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