Silverberg Group - Bringing Your Employee Benefits into Focus

April 2013 Newsletter

Group Outside Canada: Emergency Travel Coverage

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A medical emergency while travelling can be a frightening and costly experience to you and your family.

Outside Canada Emergency Travel is included in most Group Employee Benefit Plans.  It insures you and your eligible dependents based on the dependent definition in the Group Health Policy.  For the majority of emergency travel situations, this coverage is adequate to cover unforeseen medical issues.

An ‘emergency’ means an acute illness or accidental injury that requires immediate medically necessary treatment prescribed by a doctor.

‘Emergency services’ mean any reasonable medical services or supplies, including advice, treatment, medical procedures or surgery, required as a result of an emergency.

Your Emergency Travel Coverage also includes non-medical items such as assistance with the loss of travel documents and luggage, translation service, visit by a family member if you are hospitalized, return of your body home in the event of death, etc.

Your Emergency Travel Coverage may be subject to conditions and limitations such as:

When travelling, be sure to carry your emergency medical travel card, and ensure that your travelling companions know where it is.  If an emergency occurs, it is important that you or a person travelling with you, call the toll free number as soon as possible to ensure the appropriate and timely medical treatment is provided.

Please contact your Silverberg Account Manager to provide clarification on any aspect of your Group Emergency Travel Coverage.


Trends in Health Claims

The more things stay the same, the more they change

While health claim costs continue to climb year after year, it appears there has been very little change in the actual composition of health claims over the past five years. Here are a few noticeable health claim changes from 2006 to 2011:

Drugs – while drug claims still account for the majority of health claims submitted, and the largest driver of claim costs, the total share allocated to drugs has decreased by over three per cent of total claims within the past five years. This is due for the most part to recent legislative changes around generic pricing, and to several large brand name drugs coming off patent.

Hospital – hospital claims are the only claim cost that has decreased over the past five years, averaging about three per cent per year of total claims costs.

This appears to reflect the push to shorten hospital stays and move patients to out-patient care. While claims for private and semi-private rooms have decreased, costs associated with out-patient procedures and user fees have increased. Out-patient costs passed onto the claimant have virtually doubled over the five-year study period, increasing by approximately 15 per cent per year. Hospital user fees, while still only changes in rare situations, have increased by close to 33 per cent per year over the past five years.

Paramedical – paramedical claims continue to be the fastest growing cost, increasing its share of claim costs by almost three per cent within the past five years. Traditionally, the growth in paramedical claims has been driven mainly by massage, chiropractic, and physiotherapy claims. While these still represent the three largest types of paramedical claims, other paramedical benefits such as acupuncture, osteopath treatment, and athletic therapy have been the fastest growing over this time.

Vision Claims – probably the most surprising result is vision claims have stayed close to the same proportion of total claims over the last five years. Vision benefits have arguably had the best cost controls in place, with a fixed spending limit across most benefit plans. Despite these fixed maximums, the cumulative annual growth of vision claims has been about 6.5 per cent per year for the past five years. As most benefit plans have not increased their maximums within this time, the results suggest two things: more people are using their visioncare benefit and the maximum benefit is being reached more often. One source of increased spending is prescription sunglasses claims. The claim costs associated with prescription sunglasses claims have grown by about 34 per cent per year. Lens tinting costs have increased by 18.5 per cent per year. Over the past five years, we’ve also seen a decrease of about 13 per cent in costs related to glasses repairs and adjustments. This suggests that claimants are more likely to replace glasses than repair them, resulting in greater costs to the plan.

Source: Great West “Data Driven 2012″