Les assureurs estiment que l’augmentation de l’utilisation au niveau des soins de santé est autour de 15 % par année. La part des soins paramédicaux ne cesse d’augmenter et il n’est pas rare de voir que les réclamations des soins paramédicaux dépassent 25 % du total des réclamations.

Les principaux facteurs alimentant cette tendance sont le vieillissement de la population, le stress et la recherche de solutions en dehors de l’industrie de santé traditionnelle.

Les augmentations annuelles du coût de l’assurance collective poussent les employeurs à rechercher des solutions afin de contrôler les coûts et surtout maintenir une protection abordable. Les mesures qu’un employeur peut entreprendre sont variées et se répartissent à trois niveaux soit :

* Modifications au régime
* Utilisation de compte de frais médicaux
* Communication

Modifications au régime
L’employeur a le choix entre une panoplie de mesures lui permettant d’influencer l’utilisation des paramédicaux et en conséquence le coût des protections.

La franchise et la coassurance sont des mesures classiques qui permettent de transférer une partie des coûts aux employés et du fait même les conscientiser davantage sur l’utilisation des soins. Une augmentation de la franchise ou une réduction de la coassurance permettent de réduire l’utilisation.

Cependant, les employeurs optent de plus en plus pour deux niveaux de franchises et de coassurance. Ainsi, les médicaments auront une franchise séparée de celle des autres frais. La coassurance pour les soins paramédicaux peut être aussi différente de celle des médicaments.

La plupart des polices d’assurance collectives offrent un maximum par professionnel. Il est possible de réduire le maximum annuel (par exemple de 500 $ à 300 $) ou bien le transformer en un maximum global combiné pour tous les professionnels. Une combinaison des deux mesures et le promoteur de régime pourra obtenir une réduction des taux de l’assurance santé autour de 10 %.

La forte augmentation de certains soins professionnels (naturopathe, massothérapeute …) pousse les promoteurs à remettre en question la présence de certains professionnels dans la liste des spécialistes couverts. Ainsi, certains employeurs optent pour une liste de professionnels réduite (psychologue, physiothérapeute, chiropraticien). Cette mesure peut permettre une réduction des coûts des soins de santé autour de 10%.

Par ailleurs, une pratique de plus en plus populaire, consiste à exiger une recommandation médicale obligatoire avant que l’assureur rembourse certains frais.

La dernière mesure et la plus drastique que nous présentons est celle du retrait total de la protection des paramédicaux. Cette mesure peut s’accompagner de la mise en place d’un compte de frais médicaux.

Mise en place d’un compte de frais médicaux
Un compte de frais médicaux ressemble à un budget que l’employeur met à la disposition afin de rembourser certaines dépenses en soins de santé non couvertes par la police d’assurance collective. Ainsi, certains employeurs optent à utiliser le compte de soins médicaux pour compenser des coupures.

Il s’agit d’un outil efficace de gestion des coûts car l’employeur connaît à l’avance le coût maximum et le compte de frais médicaux aide à réduire les risques financiers liés aux fluctuations des demandes de règlement.

Communication
Nous constatons que les employés ne comprennent pas la dynamique financière d’une police d’assurance collective. Le promoteur de régime doit informer les employés et les conscientiser en ce qui concerne l’utilisation de leurs protections.

L’objectif lié à l’offre d’une couverture paramédicale est de permettre aux employés de rester en bonne santé et de conserver leur capacité fonctionnelle. Par conséquent, l’utilisation de ces soins continuera d’occuper une place importante dans les soins de santé complémentaires.

Avant de passer à l’action avec des coupures et des modifications au régime actuel, il est important de faire une bonne analyse de l’utilisation afin de faire des choix éclairés. En plus, il faut prendre en considération certains facteurs comme la culture propre à l’entreprise, l’industrie dans laquelle elle opère et la composition démographique de ses employés (âge, sexe, origine ethnique…).

Enfin, aspect très important sur lequel on insistera jamais assez, les décisions concernant le régime d’assurance collective doivent être communiqués et expliqués aux employés. En faisant le nécessaire, les promoteurs de régimes n’en sortiront que gagnants.
[1] Liste des professionnels qui peuvent être couverts dans la protection des soins paramédicaux : Acupuncteur, Chiropraticien, Diététiste, Ergothérapeute, Kinésithérapeute, Naturopathe, Orthophoniste, Ostéopathe. Physiothérapeute, Podiatre, Psychologue…etc.

There are many cost containment options available to reduce the costs of a benefit plan; some that have an immediate impact are;

PROFESSIONAL SERVICES:

In the last few years, claims for professional services have increased at a quick pace. Today, they represent an important portion of health claims. This has forced employers to consider a global combined maximum for all professional services instead of a maximum per service. Another method to lower the cost of benefits is to reduce the yearly maximum. Professional services represent approximately 15% of the total premium. These benefits may have an immediate impact on reducing costs of a health insurance premium.

DEDUCTIBLE:

The role of a deductible is to control the costs of a plan by eliminating small claims that should not be covered in a group plan. Insurance is a tool to protect against important and catastrophic risks. The deductible is a fair amount that would not affect the financial situation of an insured individual. A yearly deductible of 100$ is a minimum that should be used in insurance plans today.

Employers do not often adjust deductibles in order not to disappoint their employees. The present economic situation is a good time to optimise and update a group insurance plan.

DRUG CARD:

Insurers offer a discount when a deferred card is used instead of a direct card. This change reduces the health insurance cost by 5% to 9%.

With a deferred card, an insured individual will pay the full price of the claim and then be reimbursed a few days later. The pharmacist transmits the claim to the insurance company.

VISION CARE:

It is important to question the existence of vision care in a Group Insurance Plan.

When comparing the premium paid for the benefit versus the amount insured, for example, 200$ every 24 months, more employers are opting not to include vision insurance in their plan. Vision insurance can represent 10% of the health insurance premium

DENTAL CARE:

Dental care is an optional benefit in a Group Insurance Plan. To significantly reduce the cost of this benefit, one can decrease the amount reimbursed. For example, if we offer a reimbursement of 70% instead of 80%, the dental care premium will decrease by 15%. It is also very important to analyse and justify the deductibles and annual maximums in order to control the cost.

When modifying a Plan, it is very important not to relay the wrong message to employees; that is, to communicate the changes and maybe implicate them in the process. In these tough times employers need the full support of their employees.

Presented in this article are some of the cost efficient options available to any employer. There are many more available that may be recommended once an in depth analysis is made of your group insurance plan. If help is required, contact us. (Click here for the contact page)

Sleiman Karam, MBA GBA

Advisor in group insurance plans

Expatriates have special insurance needs that should be carefully analysed in order not to expose expatriates to risks that they should not take. Everyone has different needs and priorities for their insurance coverage. International insurance plans today offer the flexibility to meet the requirements of expatriates living around the world.
International insurance companies have long served expatriates around the world and understand the unique needs of expatriate life abroad. Insurance policies issued by local insurance carriers fail to cover when you are on assignment abroad.

A globally portable International Insurance plan is essential to guarantee your health insurance coverage anywhere in the world. No matter where in the world you live or travel, you will be assured of having comprehensive healthcare protection. These policies will continue coverage if the insured returns to his country of origin definitely or temporarily. This is a very important aspect since with age we can become uninsurable for medical reasons.

Protections available:

1- Global Disability plan

A global income protection plan will offer you a replacement of your income in the case that you are unable to work due to a long term illness or accident. With advances in modern medicine, you are more likely to survive a serious illness or accident than die from it. The insurance company will pay up to 75% of your salary (or insurable income) while you are medically certified as being unable to return to work, till you attain 65 years of age if necessary.
Medical underwriting is required (medical questionnaire and testing) before the insurance company offers coverage.
2- Global Life insurance
A Global Life insurance plan will give you the peace of mind that your family or dependents will be secure financially.
3- Medical and dental insurance plan
Having the peace of mind that, should anything happen to you, you will have access to the best facilities and the best treatment (whether locally, nationally or in another country entirely) is considered priceless to most expatriates.
Plan benefits summary:
- In patient and day patient accommodations
- Drugs
- Surgery
- Outpatient (physician, specialist, treatment, and tests)
- Emergency evacuation
- Maternity – optional plan – (Complication and/or normal maternity)
- Psychiatric care

It is essential that expatriates and their families profit from a comprehensive and adequate insurance plan in order to maintain their quality of life and insure financial stability in the case of a major illness or accident.

Some insurance companies specialize in the expatriate market and offer the needed benefits to attain this objective. It is very important to deal with an advisor experienced in the expatriate field and who has access to all the insurers serving this market.

It is important to note that insurance companies use a higher inflation rate when renewing group insurance contracts. They justify these inflation rates used (6% to 11%) by a combination of higher fees guide and an increase of the dental plans’ utilization (more claims).

These yearly increases in a difficult economic environment might encourage some employers to remove the dental plan or reduce the benefits. We work closely with our clients to help them contain the costs of this benefit and limit the increases by implementing a variety of measures. Some of the measures we can use are the increase of deductibles, change the frequency of the recall exam, lower the annual maximum.

For more information on the new fees increases in the provinces and territories please consult this document from Sunlife.

How can I provide workers compensation for international and multi-state employees ?

“My small business has found that trusted employees can live in other states while providing quality work outcomes. As we are preparing to expand our service on contract globally, my traveling employees will need health and workers compensation insurance to protect their health while on the job.

I phoned an insurance agent locally who recommended that an international provider of insurance plans may be the best method to write a policy for us. Does anyone know of this type of service/provider?”

Here is my answer, as published on LinkedIn:

Hello Laura,

I am an insurance broker and specialize in the expatriate insurance market. Some international insurance companies specialize in the expatriate market.

In the US I deal with companies like Cigna and International Medical Group. I also deal with many Canadian and European insurers that also service this market.

The pricing is based on the age and area where the expatriate will be living.

If I can be helpful please contact me.

Regards and happy new year,

Sleiman Karam, MBA
www.sleimankaram.com
514-910-5180