Employee Benefits Basics

Anti-selection is the practice of choosing to not buy insurance when you are healthy (or don't need to make a claim) and only buying insurance when you know you are about to make a claim. This is why there are rules in group benefit plans around enrolment windows, late applicants, waiting periods, and mandatory group participation. It's important as a broker to follow these rules. It's important a...

What does it mean when a benefit is experience-rated? How can you negotiate down your premiums with more knowledge and more clarity into how premiums are priced? In this episode, we discuss how the majority of the benefits categorized under "health" or "dental" are not insurance. They are an expense account that is outsourced to a third-party who happens to be an insurance company.

Getting licensed to sell benefits is simple. Here, we outline the steps on how to get set up: Find your provincial regulator (FSRA in Ontario) and read their instructions clearly on how to get licensed to sell life insurance and accident & sickness insurance. Find an LLQP course provider and sign up.  Take the course and practice exams until you are confident in your ability to pass. The...

1 in 6 couples of child-bearing age are struggling with fertility. They are having to pay out -of-pocket for treatments such as in-vitro fertilization (IVF), IUI or AI (artificial insemination) because they have a medical condition that requires some additional help to conceive. It's not just women - sperm counts have plummeted over the last 20 years according to the WHO (thanks to cell phones in...

When you are selling a group benefit plan, you have to interact with Users and Choosers. Users are Plan Administrators and Plan Members - that is, employees who make claims and the office admin staff who have to administer the plan on a daily basis. Examples include HR Managers, Office Managers, CFOs, Controllers, and so on. There are also Choosers - the group who ultimately make the decision and...

ASO stands for Administrative Services Only. It means that a group benefits plan sponsor (an employer) has chosen to self-insure a part of their benefit plan, usually the health and dental portion. Here's a summary on what that is and the difference between ASO and fully-insured benefit plans. 

Insurers often make exceptions when claims have been declined. There is a way to overturn claims, but it involves looking at the amount of risk involved, whether the plan is in a surplus or deficit, reading the fine print, and if the insurer wants the customer business badly enough.

Many companies are faced with an increase in group benefits premiums at the annual renewal time. Many of them will negotiate. Some of them will choose to shop the market of other insurers, get a lower rate, and switch away. Insurers know this, which is why they are willing to give customers almost any rate they need to get the deal. After the first or second renewal, they will slam the customer wi...

Find out the basic of what Best Doctors or Second Opinion Consult covers, the basic pricing, and whether it makes sense to include this in a Canadian employee benefit plan.

What do carriers mean when they say 'IBNR?' The 'incurred but not reported claims reserve' is an important part of what a group benefits client is paying in their premiums. This episode will explain what it means in real-world terms, what is a fair IBNR to build into rates, and talk about how it exists with group health & dental benefits, as well as group LTD or Life insurance. Questions? Emai...

You've just landed your first client, and it's time to transition carriers. Great! Now what? This episode will simply cover how to craft the termination letter so that you are leaving all of your options open. It's always a good idea to leave an insurer or carrier with respect and grace, so that if you need to ask for their help after transition, you haven't burned a bridge. Questions? Email us at...

I hear advisors talk about how they feel obliged to spend money on their clients. Entertaining, sports tickets, HR software, charity events...there are an endless number of ways to over-spend your commission on group benefits clients. Some advisors express unhappiness that they end up in a negative position in order to keep the group. I'm here to say that you can win an account without spending mo...

What is Target Loss Ratio? How does that compare with Actual Loss Ratio? What does it include? How would you explain this to your client? Is it better to have a low TLR or a high TLR?

Aloha! This audiobook is a chapter-by-chapter guide to the technical aspects of the Canadian group benefits business. Designed for advisors, we get into the nitty gritty of how renewals are calculated, the marketing game, how to negotiate and build relationships with carriers, how to get favours and exceptions for your clients, and all of the minutia of group health insurance. If you'd like to be...