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Group Life Insurance Toronto

Under a normal underwriting arrangement, prescription drug plans and dental care benefits can be experience rated while the group life benefits are fully pooled. The benefits of life insurance and dependent life insurance are based on the age and volume distribution of the group plan.

When you are working with an experience rated basis the annual renewal action is based on the financial results that are generated by the utilization of each of the individual employee benefit plans under a given type of insurance. Where applicable, this takes into account the plan’s past performance and is also figured with the market conditions and the general market rates.

When looking at the enrollment of the plans there will be more emphasis placed on your individual experience. Of course the smaller the population is the less emphasis will be placed on the experience of the group and the pool of the insurer.

In a situation that is fully pooled the carrier of the plan will assume the entire financial risk and there will be no accountability of the premiums versus the claims and experience. When looking at the renewal premium rates these will be fully pooled benefits such as group life and group long-term disability. It is based on a combination of aggregate experience of the insurer’s pool similar to a business.

See below for examples. You will see that Plan B is approximately 25% lower in cost than Plan A.

In the examples below, Plan B is approximately 25% lower in cost than Plan A.

Life insurance

Sample Plan A Sample Plan B

Flat $25,000. The coverage reduces by 50% at age 65 and terminates at age 70. Flat $25,000. The coverage reduces by 50% at age 65 and terminates at age 70.
Accidental Death & Dismemberment

Sample Plan A Sample Plan B

As per the principal sum above As per the principal sum above
Dependent Life
Sample Plan A Sample Plan B

    • Spouse: $5,000

 

    • Child: $2,500
    • Spouse: $5,000

 

    • Child: $2,500

 

Health care
Sample Plan A Sample Plan B
Deductibles
None apply (can be included as an option to reduce cost) • Family: $50 per year
• Single: $25 per year

Drugs

  • 100% pay direct with a drug card
  • Dispensing fee is covered
  • Unlimited maximum • 80% pay direct with a drug card
  • Dispensing fee is not covered
  • $5,000 annual maximum per person

Supplementary health care
100% coverage 80% coverage

Hospital coverage
Semi-private ward, health care deductibles and reimbursements apply where applicable Semi private ward not covered

Nursing care
$10,000 per calendar year $10,000 per calendar year

Ambulance
Transport to nearest hospital Transport to nearest hospital

Accidental dental
Covered Covered

AIDS Services Supplies

    • Purchase of prosthetic supplies
    • Purchase or rental of wheelchair, hospital bed or other durable equipment
    • Purchase of prosthetic supplies
    • Purchase or rental of wheelchair, hospital bed or other durable equipment

Out of province/country

  • Emergency Medical Treatment and travel assistance
  • Travel 100% co-insurance
  • Emergency Medical Treatment and travel assistance
  • Travel 100% co-insurance

Paramedical
$500 per practitioner per year $350 per practitioner per year with a $25 per visit maximum
Vision
Sample Plan A Sample Plan B
None None
Dental care
Sample Plan A Sample Plan B
Deductible

  • Nil
  • Basic and preventive
  • Family $50 per year
  • Single $25 per year
  • Basic and preventive

Recall

  • 6 months
  • 80% co-insurance on covered charges
  • Current fee guide
  • 9 months
  • 80% co-insurance on covered charges
  • Current fee guide

Major dental
None None

Annual maximum
$1,500 per person $1,000 per person
Long term disability
Sample Plan A Sample Plan B

Monthly benefit
67% of monthly earnings to a maximum benefit of $5,000 –

Waiting period
120 days of total disability –

Benefit period
To age 65 –

Own occupation definition
24 months and then an any occupation definition will apply –

Offsets
Primary offsets with EI, WSIB, CPP/QPP –
If the Long Term or Short Term Disability Premiums are paid by the employee then the benefit is not taxable.
Short Term Disability can also be included and where requested, this benefit will be quoted as an option as is the case with Long Term Disability as well.
What if I’m losing my group benefits?
If your group benefits plan is terminated, perhaps because of a change in employment status, don’t worry; you have options!
You have the right to exercise your conversion option contained in the policy, often without having to undergo a further medical examination. However, the premiums are often much higher than standard premiums, and the insurance company does not give you a choice of plan. (This is because those who take advantage of this opportunity cannot buy standard insurance.)
If you believe that your health is good enough to be underwritten then complete and submit the form at the bottom of this page. We’ll get back to you promptly with a quote.
As a general rule, the conversion must be performed within 30 days of termination.
This is a general statement of information. Always refer to your policy booklet for conversion options and other details. (If your group benefits plan was brokered by Blue Umbrella Financial Services, you can see your booklet online here.)

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