Plan Administrator's Workshop
      November 27, 2012
Agenda
 • 10.00am. Refresh the basics
    •Enrolments, Terminations, Troubleshooting
 • 11.00am. Beyond the basics
    •Maintenance Drugs
    •EI Premium Reduction Program
    •Government Benefits
    •Paramedical Expenditures
    •Legal Issues
 • 12.30pm Lunch
 • 1.30pm Prize Draw
 • 1.35pm Martin Walker from Co-operators
 • 2.30pm Trends in Fraud, Drug Laws & OHIP Offloading
 • 3.00pm Stress-Busting Techniques from Evelyne Mitskopoulos
You are an “agent of the
insurance company”

What does that mean?
We have seen Murphy’s Law happen
repeatedly.

The rules of insurance are not fun,
convenient, or easy to remember, but
they must be followed.
Administration
• As the administrator:

  • Inform Beneplan of any new hires, changes and terminations.

     •Examples: change in name, marital status, dependents,
     beneficiary, addition/removal of Co-ordination of Benefits,
     current address ->most important.

  • It is important to include the main reasons for any changes made
  within 31 days of the effective date.

  •Changes reported more than 31 days after the dates of change may
  require health evidence of insurability
The Plan Enrollment
• It is strongly recommended that you enroll new employees as
  soon as they are hired, and then Beneplan will be able to track their
  effective date.

• Please avoid enrolling employees or their dependents late.

• Employees are eligible to enroll if they satisfy the following:

  - Must be covered under provincial government health insurance plan.

  - Must be an active full time employee
Accuracy
    is
Paramount
Choose
only one
option
Still must
provide info on
dependents
(spouse/
children) if
have DGL
The Enrollment Forms
•The employer must submit the form no later than 31 days of
satisfying employee/dependent’s eligibility requirements to
Beneplan Administration.
Waiving the Waiting Period
- In order to waive the waiting period the employee must have had
previous benefit coverage within 3 months prior to the hire date,
specifically life coverage.
-The “Application to Waive the Waiting Period” form must be
completed by the employee and submitted to Beneplan.
- It is an application, not a request. Do not promise anything to
new employees until you have heard back.
Dependents are covered if…
 • They are first covered under OHIP or another provincial plan

 • If the dependant child is under age of 21 not working more than 30
 hours a week.

 • If the dependant is over age 21 but under age 25 and registered as a
 full time student in Canada.

 • If the dependant child is permanently incapacitated at any age, proof
 of infirmity must be submitted within 31 days of the child reaching age
 21.

 • If the dependant’s spouse is a person of the same or opposite sex to
 whom you are legally married, or which whom you have lived
 continually in a common-law relationship for more than 12 months
 and publicly represent as our spouse.
Late Applications
Late Applications
• If employees fail to enroll in the Plan within 30 days of
 meeting the eligibility period, they are deemed to be late
 applicants

• The employee and his/her dependents must submit “Health
  Evidence Form”

• Original form must be submitted to Beneplan for approval
  by the Co-operators

• Additional medical information may be requested

•    It is possible that some or all of the requested
    benefits are declined temporarily or permanently
Late Applications
    • This is one of the most common way which P.A.s create
      liability for their employers



                                           Enrolment
                                             Form
                                           Submitted
                                             With
 Date        Effective                      Health             Benefits
of Hire        Date                        evidence           Approved


                                                    Date of Death

Do you think the insurance company would pay their life insurance claim?
Late Applications
                      Enrolment
                        Form
                      Submitted
                        With
 Date     Effective    Health      Benefits
of Hire     Date      evidence     Declined


                                   You must
                                     tell the
                                   employee
                                  that he/she
                                    does not
                                      have
                                    benefits
Expatriate Coverage:
Your employees abroad
  • Consider if you need to obtain expatriate coverage for them

  • OHIP is not interrupted when a Canadian leaves country under
    180 days

  • Possible to obtain an extension from OHIP under some
    circumstances

  • OHIP does not pay for drugs and dental (unless emergency)

  • Neither OHIP nor your Out-of-country coverage will pay for
    routine items (doctors’ visits, etc)

  •    Out-of-country coverage only covers “emergencies” only and lasts
      90 days (60 if over 65)
Inpatriate Coverage:
Foreign employees coming to work for you
   • Group health insurance plan only covers employees who
     have OHIP or provincial HIP

   • When people arrive to Canada, they must wait 3 months
     before OHIP is effective

   • If you want to provide health insurance to them in that 3
     month window, you must purchase it from a separate
     company

   • http://www.travelinsurance.ca/plans/visitorsGeneral.php

   • 1-800-379-9628
Out of Country Coverage
 • Absolutely critical to call the
   number on their out of country
   card before paying the any foreign
   medical provider

 • Upon calling, the insurance
   company negotiates a fair market
   price with the medical provider

 • If they are not called, it is possible
   the employee will be overcharged
   and not be able to claim the full
   amount upon return to Canada

 • Communicate this to all employees
Many Hospitals are For-Profit
$70,000 4-night hospital stay in PA
(motorcycle accident)

$15,000 1-day hospital visit in LV
(ear infection)

$30,000 4-night hospital stay in India
(Owner of company said, “What? I am from that
part of the world. I can buy a hospital for $30,000”).


Fair market pricing applies

Canadians are frequently overcharged
Terminations / Non Active
Employees
 •   The employee quits or resigns with notice
       - The termination date would be the last day worked.

 •   The employee is being fired for cause
       - Terminate the coverage on the day the employee is fired.

 •   Voluntary leave of absence
        - The company may choose to suspend or extend benefits during the
     absence.

        - Let us know before you offer to extend benefits.

        - Your decision must be communicated in writing to the employee.

        - If the company chooses to extend benefits, the company must apply for
          a Letter of Agreement (LOA).
Terminations / Non Active
Employees
 •   Company Lay off – the layoff expected to be less than 13 weeks

 • The Employment Standards Act (ESA) states that companies that lay
   employees off temporarily up to 13weeks, are not deemed to have
   terminated these employees;

 • In this case, the company may choose to suspend benefits during such
   layoff or may choose to extend benefits during the layoff.

 • If the company chooses to extend such coverage, the company must
   apply for a Letter of Agreement (LOA).

 • All benefits, with the exception of short/long-term disability, out-of-
   country coverage and weekly indemnity can be continued, up to 13 weeks.
   After 13 weeks, only health & dental may be covered, up to 35 weeks.

 • This must be documented by the way of LOA.
Terminations / Non Active
Employees
• Company Layoff – the layoff expected to be more than 13 weeks

      - The Employment Standards Act (ESA) states that companies that lay
employees off for longer than 13 weeks, the employees are not deemed
terminated if the company extends all their benefits.

      - In this case the company must apply for a Letter of Agreement (LOA).

      - All benefits, with the exception of short/long-term disability and out-of-
       country coverage can be continued, for a period of up to one year. This must
       be documented by the way of LOA.
Terminations
6. Benefits during the notice period

The ESA requires that all benefits, including disability, must continue,
whether the employee is actively working or not, for the number of
weeks, set out by the Employment Standards Act (ESA)

                            For Ontario:
         Working for 3 months or more; less than 1 year (1 week)
              1 year or more; less than 2 years (2 weeks)
              3 years or more; less than 4 years (3 weeks)
              4 years or more; less than 5 years (4 weeks)
              5 years or more; less than 6 years (5 weeks)
              6 years or more; less than 7 years (6 weeks)
              7 years or more; less than 8 years (7 weeks)
                       8 years or more (8 weeks)
Terminations / Non Active
Employees             Ask us before you
                       offer a package!
 • Severance
      - Extension of benefits beyond the “Notice Period” requires legal
 documentation between the employer and the insurance carrier.

       - All benefits would be extended, with the exclusion of any disabilities (short or
         long) and out-of-country coverage (on health).

        - The employer must inform Beneplan if they wish to extend benefits beyond
 the termination date or notice period.

       - An LOA is required in this case.

 • Survivor Benefits
        - In the event of an Employee's death, the coverage for an insured dependent
  with respect to extended health care and dental benefits will continue for    usually
 two more year.

       - Premiums are paid entirely by the employer.
Other Leaves-per the Employment
Standards Act (ESA)
 Compassionate Leave (Family Medical Leave)

 • Under the ESA the employee is eligible to family medical
   leave up to eight weeks job-protected leave.

 • The coverage will be extended for all benefits in effect prior to
   the leave. Employers must continue paying their share of
   benefits premiums.
Other Leaves-per the Employment
Standards Act (ESA)
  Pregnancy/Maternity/Paternity Leave

 • Under the ESA where an employee takes maternity/paternity leave, the employer
   must keep all of the benefits that were in force prior to the leave.
 • If premiums for WI and LTD are paid during maternity/parental leave, the
   employee will be eligible for disability coverage.
 • If premiums are not paid, there would be no disability coverage.
 • No letter of agreement is required here.

 What if the employee pays a portion of the benefits?

 • Employee must continue to pay during leave
 • Usually done by sending cheques to the order of the Employer
 • If he/she does not pay, send 2-3 letters of warning before cutting off the benefit
 • However, we recommend you continue paying the premium anyway, and thus
   continuing the disability benefit, to protect against the worst case scenario
Other Leaves-per the Employment
Standards Act (ESA)
• Emergency Leave
    - Under the ESA if the employee is entitled to personal emergency leave then
       the employee will be on an unpaid, job-protected leave of up to 10 days
      each calendar year.

      - The employer must continue benefits while an employee is on personal
        leave.

• Vacation Periods Extended
     - If the employee on vacation (either in or out of country) and the employer
       decides to allow the employee to extend the employee’s vacation, then
       coverage for all benefits would continue to be in force, depending upon the
     duration.

      - No letter of agreement is required here.
Sick Leave
  Sick Leave
    - Under the ESA if the employee is on sick leave or short term disability then
    he/she has the right to continue with their employment contract.

 When an employee needs to take extended time off:

 1. Notify Beneplan
 2. Fill out an ROE for EI sickness benefits – select the appropriate box
 3. While the employee is on STD, start to apply for LTD – get forms from Beneplan
 4. LTD waiting period is 4 months (usually)
 5. If sick leave is extended, apply for Life Waiver of Premium – ask Beneplan
 6. If they come back to work, notify Beneplan again
 7. Keep him/her on benefits for the first 6 months – refer to your booklet to see
    how long they stay on benefits
 8. While they’re on benefits, they’re required to continue to keep paying their
    portion of the premium
         1.    If they fail to do so, you can terminate them from benefits, but must
               give ample notice first (similar to maternity leave)
...but it’s the employer’s choice
Not Actively At Work
 • “NAAW” employees are not covered for benefits

 • If an employee dies while NAAW, insurance
   company declines life claim

 • Spouse usually sues all parties and usually wins a
   settlement

 • Prevent this by letting us know as soon as someone
   goes off work
What to do with unusual situations
 1. Let us know as soon as possible
 2. Ask us before you offer a benefit package in severance
 3. Communicate clearly with employee the risks in writing
 4. Follow the rules of insurance
New Rules for AD&D and CI
• The federal budget presented on March 29th, 2012, outlines a new
  rule which requires employers to include Accidental Death &
  Dismemberment (AD&D) and Critical Illness (CI) premiums
  with employee’s taxable incomes.
• If the employer is paying for the AD&D and CI benefit, employee
  must pay tax on premiums
• Starts in 2013 – so the T4s you prepare for 2013 in late
  2013/early 2014 must include these amounts under ‘taxable
  benefits’
• Includes contributions you make from March 29-Dec 31/2012
  for benefit coverage in 2013 (to avoid loophole)
• For Quebec employees, this only impacts federal income tax.
  There is already a provincial rule which considers these benefits.
New Rule for Weekly Indemnity
• Starting in 2013, benefits paid out for self-insured short term
  disability (weekly indemnity) plans will now be subject to CPP
  and EI deductions in addition to the income tax it is already
  subject to.
• If you have STD/WI with Beneplan, we will take care of that for
  you
Don’t Forget…
• Life insurance (including DGL*) is a taxable benefit – add to T4s
• Employees must pay if LTD benefit is non-taxable upon
  collection
• If LTD benefit is non-taxable, and you do not charge employees
  for their portion of the premium, you must add the premium
  onto T4s
• New dependents, beneficiaries, etc


*Dependent Group Life
Update salaries immediately
• If you have a plan where benefits such as Life or LTD are
  calculated as a % of income (e.x. Life is 2x income; LTD is
  66.67% of salary), you must report new salaries
• There have been cases where the plan administrator forgets to
  update salaries, an employee becomes disabled, and the salary
  on file is $50,000 – but he is actually now making $80,000.
• The insurance company paid based on what is on file. Further,
  LTD premiums are dependent on volume of coverage.
• The employee sued for the difference.
While on Long Term Disability (LTD) - No premium for LTD

• In case an LTD claim is approved or in case of total disability of an
  employee as a result of accident, sickness or disease where no LTD
  coverage is available, the employee maybe eligible for premium waivers
  of life, AD&D and/or DGL if covered.

• Your employer should have a benefit coverage policy that allows the
  disabled employee to continue health and dental benefit for a particular
  period of time as spelled out in the policy. Beneplan inserts this
  automatically, but you have authority over this clause.

Applying for Life Insurance Conversion

• Within 31 days of group life insurance termination, the employee may
  obtain an individual policy with The Co-operators without providing
  evidence of good health.

• The employee has to call a Co-operators agent to do so.
Troubleshooting Claims
 • It is important to note here that no claim will be accepted or
   processed if submitted after 12 months of service date.

 • Has the pharmacist entered the Carrier Code instead of the
   Group Policy #?
    •The carrier code means the insurance company
    •The carrier code for dental is 606258; for drugs, it’s 97
    •These are not the group policy #s
Troubleshooting Claims
 • What is the error message?
   •“This person is not covered”
    •Are all names spelled correctly?
    •Is the address the same?
    •Has your dependent recently turned 21?

 • “This benefit is not covered”
    •Call 1-800-667-8164 or log online to Cooperators.ca to
    find out maximums

 • If you still experience issues, have the pharmacy call 1-866-
   394-3648 or have the dentist call 1-800-667-8164 for help.

 • Pay and submit a Claim Form to be reimbursed.
Maintenance Drugs
• When you begin a new drug, insurance companies dispense 30-
  day-supply for the first 2 dispenses, then a 90-day supply

• Reason: they anticipate drug switching

• This eliminates wastage

• If you’d like a 90-day, call 1-800-667-8164

• They’ll adjust your record

• Tell your pharmacist how much of a supply you want
EI Premium Reduction Program

Employment Insurance (EI)

EI is second payer to any employer-sponsored wage loss
replacement plan.

The wage loss replacement plan may be either insured or self-
insured.

The government recognizes that utilization will be less under EI
when an employer plan is in place, therefore they introduce the
Premium Reduction Program.
EI Premium Reduction Program
 A program which is designed to reduce the employer’s EI
 premiums payable if that employer provides wage loss
 replacement coverage that meets Human Resources and Skills
 Development Canada’s requirements

 To be considered for premium reduction, a plan that
 provides short-term disability benefits must:
     - provide at least 15 weeks of benefits;
     - match or exceed the level of benefits provided by EI;
     - pay benefits to employees after 14 days of illness or injury;
     - be accessible to employees within 3 months of hiring;
     - cover employees on a 24-hour-a-day basis.
     - pass on the savings to employees for their portion
This amount must be passed on
to employees
Company Party / Cash / Benefit Plan …


Src: http://www.servicecanada.gc.ca/eng/cs/prp/0200/0200_020.shtml#a020-4
How EI Sickness and WI programs interact
• The WI program is a replacement for EI sickness benefit
• You elect to have one or the other
• If you wish to keep the EI sickness program, but you don’t like their
  maximums, or their waiting periods, it’s possible to co-ordinate both
  benefits by using the supplementary unemployment insurance sickness
  benefit (SUB)
• The SUB plan must be registered with EI
• The SUB plan needs to be drafted to indicate exactly what’s offered
• EI requires a 2-week waiting period, the SUB plan can make payments
  during these 2 weeks without interfering with EI sickness plan
• EI would offset some payments from the employer, however, if a SUB
  plan is in place, EI will not offset any top-up payments to improve the
  maximum
Government Benefits
Other Ontario Health Programs

      Trillium Drug Program (TDP):
            - Was designed to assist Ontario residents who have high prescription
       drug costs in relation to their net household income.
            - Eligible drugs are listed in the Formulary.
            - Additional drugs may be eligible if approved through the ministry’s
       Exceptional Access Program.

       New Drug Funding Program for Cancer Care (NDFP):
             - Was formally approved in May 1997.
             - It is administered by Cancer Care Ontario, on behalf of the ministry,
        and provides about 75% of the overall funding for new and approved
intravenous cancer drugs administered in hospitals.
             - The other 25% is for older drugs which were approved prior to the
        creation of the NDFP and is covered by the hospitals’ budgets.
What if Trillium rejects me for
coverage?
1. Make an appeal to the Exceptional Access Program (EAP)
2. If that doesn’t work, call the drug manufacturer to explain your plight
   and ask to help subsidize the cost. This sort of ‘negotiation’ happens
   more often than you’d think.
3. If all else fails, write to the Toronto Star and hope that your exposure, or
   response from an editor, can help get you an exception from the EAP
Legal Issues
Risks which fall under your scope of
responsibility as plan administrator
#1 Rule: Let Beneplan Know
• There is an infinite amount of unusual and technical
  situations which could put you on the hook

• Always double-check everything with Beneplan

• It’s our job to know the fine print of your 100-page
  contract inside & out

 “Someone we laid off in February just died. I forgot to
 tell you but I’m telling you now. What do we do?”
 “We want to lay some people off – before we do, what
 are the rules of benefits around layoffs?”
Case: Disabled Employee vs. Employer
• Employee developed MS slowly over a period of 3 years
• Employee asked employer “should I start applying for
  LTD?” * Employer said “Don’t worry about it right now.”
• Employee continued to pay LTD premiums
• Employee got worse and could no longer work full time.
• Employee submits the LTD claim form but is rejected on
  grounds of “partial disability”
• Employee sues employer, Manulife, Unum, Beneplan
• Judge placed blame on Employer (plan administrator)
• Manulife and Unum were not at fault, but Judge said
  “yeah, but…you’re the insurance company.” Implying, ‘in
  reality, you have money, and you can afford to help out.’
• We’ve seen this mentality with judges countless times
  applied to employers as well

 * Here is where the P.A. could have called Beneplan to avoid the suit
Your Duty of Care
• If an employer sees than an employee is about to do
  something legal under normal circumstances, but indeed
  that employee could be causing harm to themselves, the
  employer has a duty of care to warn the employee
“Ought to have known”
• If an employee is acting in a certain fashion that under
  normal circumstances indicates that they’re facing a
  problem then the employer, then the employer, having the
  duty of care to inform, cannot hide behind the expression
  “I did not know.”

• In the common law, employers “ought to have known” if
  there is enough circumstantial evidence.
Lesson
 • Plan administrators have a positive duty to accurately
   and fully disclose to plan members all info that might
   reasonably be expected to affect employee’s benefits

 • Silence can be held against you
Refusal of Benefits
 • Life insurance and Long Term Disability should be
   mandatory or a condition of employment

 • We’ve seen:
   •An employee opt out of all benefits (incl Life)
   •…Pass away
   •…Spouse sues employer
   •…Spouse wins settlement
Refusal of Benefits
    • Some new law firms are targeting these cases specifically

    • Intent to go after the plan sponsors (not insurers) for
      failing to perform duties as plan administrators

    • Make these benefits mandatory and avoid refusals
      altogether




Source: Dave Patriarche, Mainstay Insurance Brokerage Inc.
Prize Draw
Martin Walker
The Co-operators Life Insurance Co.
OHIP Offloading
How to protect your plan against spikes in claims
Cancer drugs becoming Oral




Please put in a cap on your prescription drugs
Prescription Drug Fair Market Pricing
• Pharmacists lost a significant amount of profit when Ontario
  Minister of Health Deb Matthews outlawed kickbacks for generic
  drugs
• The government left unregulated the amount which pharmacists
  can mark up drugs to the general public
• We’ve seen a steady increase in the mark-up of prescription drugs
• If there was no mark-up, the pharmacy would have to charge $20
  dispensing fees. That’s the true cost of running that business.
Prescription Drug Fair Market Pricing

• Your plan members are only reimbursed the fair market price by
  The Co-operators

• Solutions
   •Educate employees to negotiate or switch pharmacies
   •Preferred pharmacies (Alliance Pharmacy Group)
   •Custom drug formularies (In the works with Beneplan & Co-
   operators)
2012 Fraud Trends
• 10-30% of claims are fraud / ‘innocent’ gaming the ‘system’
• We hear your employees call and ask “how can I alter this claim so
  that it’s paid even though I don’t have coverage?”
• Mentality of ‘oh well, insurance companies have tons of money.’
• It’s important that your employees realize that your employer is
  footing the bill – not the insurance company.
• If they are taking advantage of anyone, it is their employer.
• Escalating benefit costs are not sustainable, and will only lead to
  benefit cuts.
• We are willing to conduct info-sessions to communicate this &
  also encourage people to use, but not abuse
2012 Fraud Trends
• Dental receptionists submitting false claims
• Dentists up-coding for treatment
• Pharmacists fabricating claims – RCMP gets involved if it’s ODB
• Head of fraud detection at OHIP told us off the record that they’ve
  uncovered more fraud as a result of new pharmacy regulations
• Paramedicals rife with fraud, especially compression hose &
  orthotics
• Entire mafia rings dedicated to paramedical fraud
   •White collar crime is more lucrative, less physically dangerous,
   and lower penalties if caught
How Fraud Starts
                              I can get you a $400 store credit for free. Just get
                                    a prescription from a chiropractor for
                                 compression hose. I’ll give you a receipt for
                                compression hose, which you claim through
                               your benefits. Then you can buy $400 worth of
                                              products from me.

Drug Store
                                                 We have an
                 If you put                    RMT on staff. If
               through $2,500                       you put
               in claims from                  through a $500
                my wellness                        claim for
               centre, I’ll give               massage, we’ll
               you a $500 cash                 give you a $500
                 kickback.                        spa credit.

Chiropractor                                                                    Spa
How to combat Paramedical fraud?
• Request the benefit(s) you are concerned about to be subject to
  pre-approval
• This cuts down paramedical expenditures by 2/3rds
• This leaves room for you to grant more money to the people who
  truly need it vs. those who use it “just because”
• 2 pairs of custom orthotics for $60 at Costco
• Can direct Beneplan to pay these claims for you
Narcotic Abuse   • Narcotics
                   Monitoring System
                   implemented by the
                   government in May
                   2012
                 • Sends red flag
                   immediately to
                   pharmacist if there
                   was poly-pharmacy
                   or double-doctoring
                 • Generic OxyContin
                   has been allowed for
                   sale, and we will
                   monitor claims
                   usage
Questions?
1.800.387.1670
x226 Evelyne Mitskopoulos paramedicals@beneplan.net
x249 Vincenza Principato vinenza@beneplan.net
x252 Yafa Sakkejha yafa@beneplan.net
Twitter @Beneplan
Natural Stress
            Remedies



Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Definition of Stress
The confusion created when one’s mind
overrides the body’s basic desire to choke the
living daylights out of somebody who
desperately needs it.




  Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
“Stress” refers to any reaction to a physical,
mental, or emotional stimulus that upsets the
body’s natural balance.

People, bills, work, noises,                                                            extreme
temperatures, pain, illness, traffic

Stress is an unavoidable part of life.




 Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
2/3 of doctor visits are for stress-related
ailments

90% of diseases are stress related

If you control your stress, you control
your immunity to disease




 Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Stress Symptoms
• Fatigue                                                • GI disorders
• Low energy                                             • Headaches
• Mood swings                                            • Tooth-grinding
• Appetite changes                                       • Need alcohol to calm down
• Insomnia                                               • Shallow breathing
• Lowered sex drive                                      • Nervous twitches
• Heart palpitations                                     • Cold hands
• Memory problems                                        • High blood pressure
• Lack of concentration                                  • Muscle aches or back
                                                           problems



   Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Results in “fight or flight” response due to
increased production of adrenal hormones.




Body steps up its metabolism of proteins, fats
   and carbs to quickly produce energy.

 Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
•Increased secretion of adrenaline
•Elevation of blood pressure
•Acceleration of heartbeat
•Greater tension in muscles
•Digestion slows down or stops, fats and
sugars are released from stores
•Cholesterol levels rise
•Composition of blood changes slightly
(clotting)
•Release of cortisone and cortisol (suppresses
immune system)

 Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Parasympathetic
Nervous System

Puts the body at rest
so that it can
stimulate     sexual
arousal, salivation,
urination,
lacrimation (tears)
and digestion



 Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Don’t worry, be happy




                                (Yeah, right)
Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Nutrient Deficiency
Response causes excretion of amino acids,
potassium and phosphorus, depletes Mg in
muscle tissue, stores less calcium & more

•Poor nutrient absorption, and unable to
replace them adequately
• Free radical damage, slows healing, wears
out body, increases susceptibility to illness
Daily rituals to beat stress




Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Exercise – vigorous walk is all you need
Meditate &
  Breathe
  Deeply.

Set the day’s
  tone first
thing in the
 morning.
Diet of 7 servings of fruits & vegetables takes
     the stress off your digestive system
Lots of Hydration
 to support brain
  function & for
kidneys to rid the
 body of waste &
      toxins
Sleep – less than 6 hours leaves you slower
& irritable (7-9 is ideal)




 Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Laugh
It releases
endorphins
which is a
natural stress
buster and gives
the heart muscle
a good workout.
Don’t take life
too seriously!
Have an
“attitude of
gratitude” –
living
thankfully
every day
reduces stress
Recommendations
•Don’t ignore hunger, thirst or exhaustion
•Eat diet of 50-75% raw foods
•Avoid processed foods, artificial sweeteners,
preservatives, carbonated soft drinks, chocolate,
fried foods, junk foods, sugar, white flour
products, limit red meat
•Limit or eliminate caffeine, alcohol, tobacco
•Have a regular time out → solitude


   Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Brain-Gut Connection
•We're now discovering that the composition of this
microflora has a profound impact on your health. For
example, we now know that your intestinal bacteria
influences your:
•Genetic expression
•Immune system
•Brain development, mental health, and memory
•Weight and chronic & acute diseases
•Take probiotics daily to balance gut flora

   Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Supplements
•GABA – 600 to 750 mg, 2X daily
•Complex B Vitamins – 100 mg daily
•Plus extra pantothenic acid B5 – 500 mg daily
•Vitamin C – 3,000 mg daily
•Calcium – 2,000 mg daily
•Magnesium – 600-1,000 mg daily
•Zinc – 50-80 mg daily
•Sleep: Melatonin – 1.5 mg daily, taken 2 hours before
bedtime. If not effective, increase gradually to 5 mg.



   Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Herbs
Holy Basil
1,000 mg daily
Kava kava
Relaxes the mind and body
Passionflower
Calming
Skullcap
For nervous disorders
Valerian
Keeps nervous system from being
overwhelmed and powerful sleep aid
Chamomile
Nerve tonic, sleep aid
(do not take if allergy to ragweed)



     Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
“We’ve got 1000 different diagnoses and diseases
    out there. They’re just the weak link.

     They’re all the result of one thing: stress.

If you put enough stress on the chain and you put
enough stress on the system, then one of the links
                   will break.”

                                -Dr. Ben Johnson


 Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
Request Evelyne to visit your office for
wellness presentations and speak to
employees

Evelyne Mitskopoulos C.N.P.
Director of Wellness
1.800.387.1670 x226
paramedicals@beneplan.net

Effective Benefit Plan Administration

  • 1.
  • 2.
    Agenda • 10.00am.Refresh the basics •Enrolments, Terminations, Troubleshooting • 11.00am. Beyond the basics •Maintenance Drugs •EI Premium Reduction Program •Government Benefits •Paramedical Expenditures •Legal Issues • 12.30pm Lunch • 1.30pm Prize Draw • 1.35pm Martin Walker from Co-operators • 2.30pm Trends in Fraud, Drug Laws & OHIP Offloading • 3.00pm Stress-Busting Techniques from Evelyne Mitskopoulos
  • 3.
    You are an“agent of the insurance company” What does that mean?
  • 4.
    We have seenMurphy’s Law happen repeatedly. The rules of insurance are not fun, convenient, or easy to remember, but they must be followed.
  • 5.
    Administration • As theadministrator: • Inform Beneplan of any new hires, changes and terminations. •Examples: change in name, marital status, dependents, beneficiary, addition/removal of Co-ordination of Benefits, current address ->most important. • It is important to include the main reasons for any changes made within 31 days of the effective date. •Changes reported more than 31 days after the dates of change may require health evidence of insurability
  • 6.
    The Plan Enrollment •It is strongly recommended that you enroll new employees as soon as they are hired, and then Beneplan will be able to track their effective date. • Please avoid enrolling employees or their dependents late. • Employees are eligible to enroll if they satisfy the following: - Must be covered under provincial government health insurance plan. - Must be an active full time employee
  • 7.
    Accuracy is Paramount
  • 8.
  • 9.
    Still must provide infoon dependents (spouse/ children) if have DGL
  • 11.
    The Enrollment Forms •Theemployer must submit the form no later than 31 days of satisfying employee/dependent’s eligibility requirements to Beneplan Administration. Waiving the Waiting Period - In order to waive the waiting period the employee must have had previous benefit coverage within 3 months prior to the hire date, specifically life coverage. -The “Application to Waive the Waiting Period” form must be completed by the employee and submitted to Beneplan. - It is an application, not a request. Do not promise anything to new employees until you have heard back.
  • 12.
    Dependents are coveredif… • They are first covered under OHIP or another provincial plan • If the dependant child is under age of 21 not working more than 30 hours a week. • If the dependant is over age 21 but under age 25 and registered as a full time student in Canada. • If the dependant child is permanently incapacitated at any age, proof of infirmity must be submitted within 31 days of the child reaching age 21. • If the dependant’s spouse is a person of the same or opposite sex to whom you are legally married, or which whom you have lived continually in a common-law relationship for more than 12 months and publicly represent as our spouse.
  • 13.
  • 14.
    Late Applications • Ifemployees fail to enroll in the Plan within 30 days of meeting the eligibility period, they are deemed to be late applicants • The employee and his/her dependents must submit “Health Evidence Form” • Original form must be submitted to Beneplan for approval by the Co-operators • Additional medical information may be requested • It is possible that some or all of the requested benefits are declined temporarily or permanently
  • 15.
    Late Applications • This is one of the most common way which P.A.s create liability for their employers Enrolment Form Submitted With Date Effective Health Benefits of Hire Date evidence Approved Date of Death Do you think the insurance company would pay their life insurance claim?
  • 16.
    Late Applications Enrolment Form Submitted With Date Effective Health Benefits of Hire Date evidence Declined You must tell the employee that he/she does not have benefits
  • 17.
    Expatriate Coverage: Your employeesabroad • Consider if you need to obtain expatriate coverage for them • OHIP is not interrupted when a Canadian leaves country under 180 days • Possible to obtain an extension from OHIP under some circumstances • OHIP does not pay for drugs and dental (unless emergency) • Neither OHIP nor your Out-of-country coverage will pay for routine items (doctors’ visits, etc) • Out-of-country coverage only covers “emergencies” only and lasts 90 days (60 if over 65)
  • 18.
    Inpatriate Coverage: Foreign employeescoming to work for you • Group health insurance plan only covers employees who have OHIP or provincial HIP • When people arrive to Canada, they must wait 3 months before OHIP is effective • If you want to provide health insurance to them in that 3 month window, you must purchase it from a separate company • http://www.travelinsurance.ca/plans/visitorsGeneral.php • 1-800-379-9628
  • 19.
    Out of CountryCoverage • Absolutely critical to call the number on their out of country card before paying the any foreign medical provider • Upon calling, the insurance company negotiates a fair market price with the medical provider • If they are not called, it is possible the employee will be overcharged and not be able to claim the full amount upon return to Canada • Communicate this to all employees
  • 20.
    Many Hospitals areFor-Profit $70,000 4-night hospital stay in PA (motorcycle accident) $15,000 1-day hospital visit in LV (ear infection) $30,000 4-night hospital stay in India (Owner of company said, “What? I am from that part of the world. I can buy a hospital for $30,000”). Fair market pricing applies Canadians are frequently overcharged
  • 21.
    Terminations / NonActive Employees • The employee quits or resigns with notice - The termination date would be the last day worked. • The employee is being fired for cause - Terminate the coverage on the day the employee is fired. • Voluntary leave of absence - The company may choose to suspend or extend benefits during the absence. - Let us know before you offer to extend benefits. - Your decision must be communicated in writing to the employee. - If the company chooses to extend benefits, the company must apply for a Letter of Agreement (LOA).
  • 22.
    Terminations / NonActive Employees • Company Lay off – the layoff expected to be less than 13 weeks • The Employment Standards Act (ESA) states that companies that lay employees off temporarily up to 13weeks, are not deemed to have terminated these employees; • In this case, the company may choose to suspend benefits during such layoff or may choose to extend benefits during the layoff. • If the company chooses to extend such coverage, the company must apply for a Letter of Agreement (LOA). • All benefits, with the exception of short/long-term disability, out-of- country coverage and weekly indemnity can be continued, up to 13 weeks. After 13 weeks, only health & dental may be covered, up to 35 weeks. • This must be documented by the way of LOA.
  • 23.
    Terminations / NonActive Employees • Company Layoff – the layoff expected to be more than 13 weeks - The Employment Standards Act (ESA) states that companies that lay employees off for longer than 13 weeks, the employees are not deemed terminated if the company extends all their benefits. - In this case the company must apply for a Letter of Agreement (LOA). - All benefits, with the exception of short/long-term disability and out-of- country coverage can be continued, for a period of up to one year. This must be documented by the way of LOA.
  • 24.
    Terminations 6. Benefits duringthe notice period The ESA requires that all benefits, including disability, must continue, whether the employee is actively working or not, for the number of weeks, set out by the Employment Standards Act (ESA) For Ontario: Working for 3 months or more; less than 1 year (1 week) 1 year or more; less than 2 years (2 weeks) 3 years or more; less than 4 years (3 weeks) 4 years or more; less than 5 years (4 weeks) 5 years or more; less than 6 years (5 weeks) 6 years or more; less than 7 years (6 weeks) 7 years or more; less than 8 years (7 weeks) 8 years or more (8 weeks)
  • 25.
    Terminations / NonActive Employees Ask us before you offer a package! • Severance - Extension of benefits beyond the “Notice Period” requires legal documentation between the employer and the insurance carrier. - All benefits would be extended, with the exclusion of any disabilities (short or long) and out-of-country coverage (on health). - The employer must inform Beneplan if they wish to extend benefits beyond the termination date or notice period. - An LOA is required in this case. • Survivor Benefits - In the event of an Employee's death, the coverage for an insured dependent with respect to extended health care and dental benefits will continue for usually two more year. - Premiums are paid entirely by the employer.
  • 26.
    Other Leaves-per theEmployment Standards Act (ESA) Compassionate Leave (Family Medical Leave) • Under the ESA the employee is eligible to family medical leave up to eight weeks job-protected leave. • The coverage will be extended for all benefits in effect prior to the leave. Employers must continue paying their share of benefits premiums.
  • 27.
    Other Leaves-per theEmployment Standards Act (ESA) Pregnancy/Maternity/Paternity Leave • Under the ESA where an employee takes maternity/paternity leave, the employer must keep all of the benefits that were in force prior to the leave. • If premiums for WI and LTD are paid during maternity/parental leave, the employee will be eligible for disability coverage. • If premiums are not paid, there would be no disability coverage. • No letter of agreement is required here. What if the employee pays a portion of the benefits? • Employee must continue to pay during leave • Usually done by sending cheques to the order of the Employer • If he/she does not pay, send 2-3 letters of warning before cutting off the benefit • However, we recommend you continue paying the premium anyway, and thus continuing the disability benefit, to protect against the worst case scenario
  • 28.
    Other Leaves-per theEmployment Standards Act (ESA) • Emergency Leave - Under the ESA if the employee is entitled to personal emergency leave then the employee will be on an unpaid, job-protected leave of up to 10 days each calendar year. - The employer must continue benefits while an employee is on personal leave. • Vacation Periods Extended - If the employee on vacation (either in or out of country) and the employer decides to allow the employee to extend the employee’s vacation, then coverage for all benefits would continue to be in force, depending upon the duration. - No letter of agreement is required here.
  • 29.
    Sick Leave Sick Leave - Under the ESA if the employee is on sick leave or short term disability then he/she has the right to continue with their employment contract. When an employee needs to take extended time off: 1. Notify Beneplan 2. Fill out an ROE for EI sickness benefits – select the appropriate box 3. While the employee is on STD, start to apply for LTD – get forms from Beneplan 4. LTD waiting period is 4 months (usually) 5. If sick leave is extended, apply for Life Waiver of Premium – ask Beneplan 6. If they come back to work, notify Beneplan again 7. Keep him/her on benefits for the first 6 months – refer to your booklet to see how long they stay on benefits 8. While they’re on benefits, they’re required to continue to keep paying their portion of the premium 1. If they fail to do so, you can terminate them from benefits, but must give ample notice first (similar to maternity leave)
  • 30.
    ...but it’s theemployer’s choice
  • 31.
    Not Actively AtWork • “NAAW” employees are not covered for benefits • If an employee dies while NAAW, insurance company declines life claim • Spouse usually sues all parties and usually wins a settlement • Prevent this by letting us know as soon as someone goes off work
  • 32.
    What to dowith unusual situations 1. Let us know as soon as possible 2. Ask us before you offer a benefit package in severance 3. Communicate clearly with employee the risks in writing 4. Follow the rules of insurance
  • 33.
    New Rules forAD&D and CI • The federal budget presented on March 29th, 2012, outlines a new rule which requires employers to include Accidental Death & Dismemberment (AD&D) and Critical Illness (CI) premiums with employee’s taxable incomes. • If the employer is paying for the AD&D and CI benefit, employee must pay tax on premiums • Starts in 2013 – so the T4s you prepare for 2013 in late 2013/early 2014 must include these amounts under ‘taxable benefits’ • Includes contributions you make from March 29-Dec 31/2012 for benefit coverage in 2013 (to avoid loophole) • For Quebec employees, this only impacts federal income tax. There is already a provincial rule which considers these benefits.
  • 34.
    New Rule forWeekly Indemnity • Starting in 2013, benefits paid out for self-insured short term disability (weekly indemnity) plans will now be subject to CPP and EI deductions in addition to the income tax it is already subject to. • If you have STD/WI with Beneplan, we will take care of that for you
  • 35.
    Don’t Forget… • Lifeinsurance (including DGL*) is a taxable benefit – add to T4s • Employees must pay if LTD benefit is non-taxable upon collection • If LTD benefit is non-taxable, and you do not charge employees for their portion of the premium, you must add the premium onto T4s • New dependents, beneficiaries, etc *Dependent Group Life
  • 36.
    Update salaries immediately •If you have a plan where benefits such as Life or LTD are calculated as a % of income (e.x. Life is 2x income; LTD is 66.67% of salary), you must report new salaries • There have been cases where the plan administrator forgets to update salaries, an employee becomes disabled, and the salary on file is $50,000 – but he is actually now making $80,000. • The insurance company paid based on what is on file. Further, LTD premiums are dependent on volume of coverage. • The employee sued for the difference.
  • 37.
    While on LongTerm Disability (LTD) - No premium for LTD • In case an LTD claim is approved or in case of total disability of an employee as a result of accident, sickness or disease where no LTD coverage is available, the employee maybe eligible for premium waivers of life, AD&D and/or DGL if covered. • Your employer should have a benefit coverage policy that allows the disabled employee to continue health and dental benefit for a particular period of time as spelled out in the policy. Beneplan inserts this automatically, but you have authority over this clause. Applying for Life Insurance Conversion • Within 31 days of group life insurance termination, the employee may obtain an individual policy with The Co-operators without providing evidence of good health. • The employee has to call a Co-operators agent to do so.
  • 38.
    Troubleshooting Claims •It is important to note here that no claim will be accepted or processed if submitted after 12 months of service date. • Has the pharmacist entered the Carrier Code instead of the Group Policy #? •The carrier code means the insurance company •The carrier code for dental is 606258; for drugs, it’s 97 •These are not the group policy #s
  • 39.
    Troubleshooting Claims •What is the error message? •“This person is not covered” •Are all names spelled correctly? •Is the address the same? •Has your dependent recently turned 21? • “This benefit is not covered” •Call 1-800-667-8164 or log online to Cooperators.ca to find out maximums • If you still experience issues, have the pharmacy call 1-866- 394-3648 or have the dentist call 1-800-667-8164 for help. • Pay and submit a Claim Form to be reimbursed.
  • 40.
    Maintenance Drugs • Whenyou begin a new drug, insurance companies dispense 30- day-supply for the first 2 dispenses, then a 90-day supply • Reason: they anticipate drug switching • This eliminates wastage • If you’d like a 90-day, call 1-800-667-8164 • They’ll adjust your record • Tell your pharmacist how much of a supply you want
  • 41.
    EI Premium ReductionProgram Employment Insurance (EI) EI is second payer to any employer-sponsored wage loss replacement plan. The wage loss replacement plan may be either insured or self- insured. The government recognizes that utilization will be less under EI when an employer plan is in place, therefore they introduce the Premium Reduction Program.
  • 42.
    EI Premium ReductionProgram A program which is designed to reduce the employer’s EI premiums payable if that employer provides wage loss replacement coverage that meets Human Resources and Skills Development Canada’s requirements To be considered for premium reduction, a plan that provides short-term disability benefits must: - provide at least 15 weeks of benefits; - match or exceed the level of benefits provided by EI; - pay benefits to employees after 14 days of illness or injury; - be accessible to employees within 3 months of hiring; - cover employees on a 24-hour-a-day basis. - pass on the savings to employees for their portion
  • 45.
    This amount mustbe passed on to employees Company Party / Cash / Benefit Plan … Src: http://www.servicecanada.gc.ca/eng/cs/prp/0200/0200_020.shtml#a020-4
  • 46.
    How EI Sicknessand WI programs interact • The WI program is a replacement for EI sickness benefit • You elect to have one or the other • If you wish to keep the EI sickness program, but you don’t like their maximums, or their waiting periods, it’s possible to co-ordinate both benefits by using the supplementary unemployment insurance sickness benefit (SUB) • The SUB plan must be registered with EI • The SUB plan needs to be drafted to indicate exactly what’s offered • EI requires a 2-week waiting period, the SUB plan can make payments during these 2 weeks without interfering with EI sickness plan • EI would offset some payments from the employer, however, if a SUB plan is in place, EI will not offset any top-up payments to improve the maximum
  • 47.
    Government Benefits Other OntarioHealth Programs Trillium Drug Program (TDP): - Was designed to assist Ontario residents who have high prescription drug costs in relation to their net household income. - Eligible drugs are listed in the Formulary. - Additional drugs may be eligible if approved through the ministry’s Exceptional Access Program. New Drug Funding Program for Cancer Care (NDFP): - Was formally approved in May 1997. - It is administered by Cancer Care Ontario, on behalf of the ministry, and provides about 75% of the overall funding for new and approved intravenous cancer drugs administered in hospitals. - The other 25% is for older drugs which were approved prior to the creation of the NDFP and is covered by the hospitals’ budgets.
  • 48.
    What if Trilliumrejects me for coverage? 1. Make an appeal to the Exceptional Access Program (EAP) 2. If that doesn’t work, call the drug manufacturer to explain your plight and ask to help subsidize the cost. This sort of ‘negotiation’ happens more often than you’d think. 3. If all else fails, write to the Toronto Star and hope that your exposure, or response from an editor, can help get you an exception from the EAP
  • 50.
    Legal Issues Risks whichfall under your scope of responsibility as plan administrator
  • 51.
    #1 Rule: LetBeneplan Know • There is an infinite amount of unusual and technical situations which could put you on the hook • Always double-check everything with Beneplan • It’s our job to know the fine print of your 100-page contract inside & out  “Someone we laid off in February just died. I forgot to tell you but I’m telling you now. What do we do?”  “We want to lay some people off – before we do, what are the rules of benefits around layoffs?”
  • 52.
    Case: Disabled Employeevs. Employer • Employee developed MS slowly over a period of 3 years • Employee asked employer “should I start applying for LTD?” * Employer said “Don’t worry about it right now.” • Employee continued to pay LTD premiums • Employee got worse and could no longer work full time. • Employee submits the LTD claim form but is rejected on grounds of “partial disability” • Employee sues employer, Manulife, Unum, Beneplan • Judge placed blame on Employer (plan administrator) • Manulife and Unum were not at fault, but Judge said “yeah, but…you’re the insurance company.” Implying, ‘in reality, you have money, and you can afford to help out.’ • We’ve seen this mentality with judges countless times applied to employers as well * Here is where the P.A. could have called Beneplan to avoid the suit
  • 53.
    Your Duty ofCare • If an employer sees than an employee is about to do something legal under normal circumstances, but indeed that employee could be causing harm to themselves, the employer has a duty of care to warn the employee
  • 54.
    “Ought to haveknown” • If an employee is acting in a certain fashion that under normal circumstances indicates that they’re facing a problem then the employer, then the employer, having the duty of care to inform, cannot hide behind the expression “I did not know.” • In the common law, employers “ought to have known” if there is enough circumstantial evidence.
  • 55.
    Lesson • Planadministrators have a positive duty to accurately and fully disclose to plan members all info that might reasonably be expected to affect employee’s benefits • Silence can be held against you
  • 56.
    Refusal of Benefits • Life insurance and Long Term Disability should be mandatory or a condition of employment • We’ve seen: •An employee opt out of all benefits (incl Life) •…Pass away •…Spouse sues employer •…Spouse wins settlement
  • 57.
    Refusal of Benefits • Some new law firms are targeting these cases specifically • Intent to go after the plan sponsors (not insurers) for failing to perform duties as plan administrators • Make these benefits mandatory and avoid refusals altogether Source: Dave Patriarche, Mainstay Insurance Brokerage Inc.
  • 58.
  • 59.
  • 60.
    OHIP Offloading How toprotect your plan against spikes in claims
  • 61.
    Cancer drugs becomingOral Please put in a cap on your prescription drugs
  • 62.
    Prescription Drug FairMarket Pricing • Pharmacists lost a significant amount of profit when Ontario Minister of Health Deb Matthews outlawed kickbacks for generic drugs • The government left unregulated the amount which pharmacists can mark up drugs to the general public • We’ve seen a steady increase in the mark-up of prescription drugs • If there was no mark-up, the pharmacy would have to charge $20 dispensing fees. That’s the true cost of running that business.
  • 63.
    Prescription Drug FairMarket Pricing • Your plan members are only reimbursed the fair market price by The Co-operators • Solutions •Educate employees to negotiate or switch pharmacies •Preferred pharmacies (Alliance Pharmacy Group) •Custom drug formularies (In the works with Beneplan & Co- operators)
  • 64.
    2012 Fraud Trends •10-30% of claims are fraud / ‘innocent’ gaming the ‘system’ • We hear your employees call and ask “how can I alter this claim so that it’s paid even though I don’t have coverage?” • Mentality of ‘oh well, insurance companies have tons of money.’ • It’s important that your employees realize that your employer is footing the bill – not the insurance company. • If they are taking advantage of anyone, it is their employer. • Escalating benefit costs are not sustainable, and will only lead to benefit cuts. • We are willing to conduct info-sessions to communicate this & also encourage people to use, but not abuse
  • 65.
    2012 Fraud Trends •Dental receptionists submitting false claims • Dentists up-coding for treatment • Pharmacists fabricating claims – RCMP gets involved if it’s ODB • Head of fraud detection at OHIP told us off the record that they’ve uncovered more fraud as a result of new pharmacy regulations • Paramedicals rife with fraud, especially compression hose & orthotics • Entire mafia rings dedicated to paramedical fraud •White collar crime is more lucrative, less physically dangerous, and lower penalties if caught
  • 66.
    How Fraud Starts I can get you a $400 store credit for free. Just get a prescription from a chiropractor for compression hose. I’ll give you a receipt for compression hose, which you claim through your benefits. Then you can buy $400 worth of products from me. Drug Store We have an If you put RMT on staff. If through $2,500 you put in claims from through a $500 my wellness claim for centre, I’ll give massage, we’ll you a $500 cash give you a $500 kickback. spa credit. Chiropractor Spa
  • 67.
    How to combatParamedical fraud? • Request the benefit(s) you are concerned about to be subject to pre-approval • This cuts down paramedical expenditures by 2/3rds • This leaves room for you to grant more money to the people who truly need it vs. those who use it “just because” • 2 pairs of custom orthotics for $60 at Costco • Can direct Beneplan to pay these claims for you
  • 68.
    Narcotic Abuse • Narcotics Monitoring System implemented by the government in May 2012 • Sends red flag immediately to pharmacist if there was poly-pharmacy or double-doctoring • Generic OxyContin has been allowed for sale, and we will monitor claims usage
  • 69.
    Questions? 1.800.387.1670 x226 Evelyne Mitskopoulosparamedicals@beneplan.net x249 Vincenza Principato vinenza@beneplan.net x252 Yafa Sakkejha yafa@beneplan.net Twitter @Beneplan
  • 70.
    Natural Stress Remedies Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 71.
    Definition of Stress Theconfusion created when one’s mind overrides the body’s basic desire to choke the living daylights out of somebody who desperately needs it. Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 72.
    “Stress” refers toany reaction to a physical, mental, or emotional stimulus that upsets the body’s natural balance. People, bills, work, noises, extreme temperatures, pain, illness, traffic Stress is an unavoidable part of life. Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 73.
    2/3 of doctorvisits are for stress-related ailments 90% of diseases are stress related If you control your stress, you control your immunity to disease Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 74.
    Stress Symptoms • Fatigue • GI disorders • Low energy • Headaches • Mood swings • Tooth-grinding • Appetite changes • Need alcohol to calm down • Insomnia • Shallow breathing • Lowered sex drive • Nervous twitches • Heart palpitations • Cold hands • Memory problems • High blood pressure • Lack of concentration • Muscle aches or back problems Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 75.
    Results in “fightor flight” response due to increased production of adrenal hormones. Body steps up its metabolism of proteins, fats and carbs to quickly produce energy. Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 76.
    •Increased secretion ofadrenaline •Elevation of blood pressure •Acceleration of heartbeat •Greater tension in muscles •Digestion slows down or stops, fats and sugars are released from stores •Cholesterol levels rise •Composition of blood changes slightly (clotting) •Release of cortisone and cortisol (suppresses immune system) Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 77.
    Parasympathetic Nervous System Puts thebody at rest so that it can stimulate sexual arousal, salivation, urination, lacrimation (tears) and digestion Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 78.
    Don’t worry, behappy (Yeah, right) Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 79.
    Nutrient Deficiency Response causesexcretion of amino acids, potassium and phosphorus, depletes Mg in muscle tissue, stores less calcium & more •Poor nutrient absorption, and unable to replace them adequately • Free radical damage, slows healing, wears out body, increases susceptibility to illness
  • 80.
    Daily rituals tobeat stress Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 81.
    Exercise – vigorouswalk is all you need
  • 82.
    Meditate & Breathe Deeply. Set the day’s tone first thing in the morning.
  • 83.
    Diet of 7servings of fruits & vegetables takes the stress off your digestive system
  • 84.
    Lots of Hydration to support brain function & for kidneys to rid the body of waste & toxins
  • 85.
    Sleep – lessthan 6 hours leaves you slower & irritable (7-9 is ideal) Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 86.
    Laugh It releases endorphins which isa natural stress buster and gives the heart muscle a good workout. Don’t take life too seriously!
  • 87.
    Have an “attitude of gratitude”– living thankfully every day reduces stress
  • 88.
    Recommendations •Don’t ignore hunger,thirst or exhaustion •Eat diet of 50-75% raw foods •Avoid processed foods, artificial sweeteners, preservatives, carbonated soft drinks, chocolate, fried foods, junk foods, sugar, white flour products, limit red meat •Limit or eliminate caffeine, alcohol, tobacco •Have a regular time out → solitude Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 89.
    Brain-Gut Connection •We're nowdiscovering that the composition of this microflora has a profound impact on your health. For example, we now know that your intestinal bacteria influences your: •Genetic expression •Immune system •Brain development, mental health, and memory •Weight and chronic & acute diseases •Take probiotics daily to balance gut flora Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 90.
    Supplements •GABA – 600to 750 mg, 2X daily •Complex B Vitamins – 100 mg daily •Plus extra pantothenic acid B5 – 500 mg daily •Vitamin C – 3,000 mg daily •Calcium – 2,000 mg daily •Magnesium – 600-1,000 mg daily •Zinc – 50-80 mg daily •Sleep: Melatonin – 1.5 mg daily, taken 2 hours before bedtime. If not effective, increase gradually to 5 mg. Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 91.
    Herbs Holy Basil 1,000 mgdaily Kava kava Relaxes the mind and body Passionflower Calming Skullcap For nervous disorders Valerian Keeps nervous system from being overwhelmed and powerful sleep aid Chamomile Nerve tonic, sleep aid (do not take if allergy to ragweed) Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 92.
    “We’ve got 1000different diagnoses and diseases out there. They’re just the weak link. They’re all the result of one thing: stress. If you put enough stress on the chain and you put enough stress on the system, then one of the links will break.” -Dr. Ben Johnson Evelyne Mitskopoulos, Director of Wellness, Beneplan Inc. 1-800-387-1670 X 226 paramedicals@beneplan.net
  • 93.
    Request Evelyne tovisit your office for wellness presentations and speak to employees Evelyne Mitskopoulos C.N.P. Director of Wellness 1.800.387.1670 x226 paramedicals@beneplan.net

Editor's Notes

  • #43 Although the Premium Reduction Program is administered through the employer’s portion of the premiums, the savings must be passed on to the employees in some form, such as a reduced contribution rate or an improved benefit.