Many people want to know how to best compare Association and Custom Benefits Plans. These Health and Dental Plans for employees come in all shapes and sizes and offer access to affordable, health and dental coverage for many of the expenses not covered by your provincial health care plan. These affordable plans are designed to fit your family’s health needs and your budget. They covers many day-to-day extended health care expenses like dental appointments, prescription drugs and eyeglasses. They can also protect you from unexpected medical costs.

At its core, an Association Benefits Plan is simply a Custom Benefits Plan that has been set up by an Association as a benefit of membership for its members to optionally participate in. Because it is a set plan there is minimal flexibility within the plan for the individual members to have their own unique coverage. However, such plans typically have a few set options so that members can select the level of coverage they want within predefined parameters. In this way smaller companies and sole-proprietors can participate in a group plan which would be out of their reach if they tried to set up their own Custom Benefits Plan. There is typically cost savings to this plan when compared to an individual plan purchased elsewhere.

Many do not realize that a Custom Benefits Plan can be created for a company with as few as 3 employees if it meets the right criteria. Still many small companies find that it is better to wait until they have 5 or more employees before they put together their own plan if they are able to take advantage of their associations’ plan and they are happy with the coverage it provides.

The following gives a broad comparison of what to expect with these two approaches to Health and Dental Plans:

Who Are These Plans For

Association Benefits Plan

Custom Benefits Plan

Any member of the Association
Self-employed sole proprietor
Small business owner with a small staff
Not covered by your employer
Not satisfied with your current health coverage

Any company with 3 or more employees (including yourself)
Not satisfied with your current health coverage
Want to provide an incentive for employee retention
Want higher coverages in certain areas (e.g. Vision, Massage Therapy, Dental, etc….)

Advantages

Association Benefits Plan

Custom Benefits Plan

It is part of a wholesale pool giving you wider coverage for lower rates
You gain access to full orthodontic care and major restorative dental care (usually these are too costly for small plans)
There is no waiting period to access the benefits (other individual plans typically have waiting periods before accessing dental benefits, or have a 3 year tiered system before they have full access to the maximums allowed in the dental benefits)

Complete flexibility on plan design
Create different tiers of benefits for different groups of employees within the company (ie. Management, Staff)
Include Contractors in your plan as a loyalty incentive.
You can have your custom plan participate in pooled benefits to take advantage of cost savings and expanded benefits.
You do not have to pass a medical exam to join the plan.

Required Benefits

Association Benefits Plan

Custom Benefits Plan

Life Insurance and Accidental Death and Dismemberment can be set up with either a flat amount in a denomination that makes sense for the average needs or based on one times or two times annual earnings.

Dependents Life Insurance provides a small amount of coverage (ie. $10,000) on your spouse, and half that amount on each dependent child.

Extended Health Coverage for yourself and your family. The plan is usually set up with three options that can be chosen from such as:

Bronze – $250 yearly deductible, 70% coinsurance
Silver – $100 yearly deductible, 80% coinsurance
Gold – zero deductible, 90% coinsurance

This benefit can be set up to pay most items that Provincial Medical does not pay for such as:

Prescriptions
Vision care
Out of Country Coverage
Semi-private hospital rooms
Other medical hardware
Professional Services (chiropractor, massage therapist, etc.)

Extended Health Coverage for yourself and your family. Since it is customized to your needs there are numerous options and combinations available.This benefit can be designed to include all or some of the items that Provincial Medical does not pay for including:

Prescriptions
Vision care
Out of Country Coverage
Semi-private hospital rooms
Other medical hardware
Professional Services (chiropractor, massage therapist, etc.)

Optional Benefits for Each Group

Association Benefits Plan

Custom Benefits Plan

Dental Care is available for yourself and your dependents. The plan is usually set up with three options such as:

Bronze – 80% of all basic items such as cleaning, scaling, X-rays, fillings, extractions, periodontry, and endodontry up to a maximum of $1,500 per calendar year per individual or dependent.
Silver – pays everything listed above, but then adds 50% of Major Restorative items such as Crowns, Inlays, Dentures, Bridgework, and extensive Periodontics are covered. The maximum benefit per individual is $1,500 per calendar year. Orthodontry for dependent children is covered at 50% reimbursement up to a lifetime maximum payout of $2,000 per child
Gold – pays everything listed in “b”, except that the basic coverages are paid at 100% instead of 80%

Dental Care is available for yourself and your dependents. You can customize the plan in any way that you want with varying deductibles for different services such as:

Basic Services
Major Restorative
Orthodontics

The other ways you can customize your benefits is by setting custom recall exam periods and custom annual maximum coverage limits.

Short Term Disability is a benefit that pays a percentage of your earnings if you cannot work by reason of accident or illness. Benefits begin on the 15th day of either accident or illness and continue for up to 15 weeks (or earlier recovery) paying 66 2/3% of net weekly earnings (after business expenses are deducted.)

Long Term Disability is provided to help you replace your earnings should you be unable to work by reason of accident or illness. Benefits begin after you have been off work for 17 weeks, or when your Short Term Disability benefits expire (if you have chosen this benefit). For both the Short Term and Long Term Disability plans, the income is usually set up to render the benefit tax-free at time of collection.

Critical Illness is available to pay you a tax free lump sum if you are diagnosed with and survive any one of a variety of conditions such as:

Cancer*	Coronary Bypass Surgery*	Heart Attack*	Stroke*
Alzheimer’s	Meningitis	Blindness	Deafness
Kidney Failure	Multiple Sclerosis	Brain Injury	Paralysis
			etc…

The *Top Four conditions are usually covered on a basic plan and a long list of additional ones on a comprehensive plan.

Employee Assistance Programs are a very new innovation for group insurance. They are designed to prevent ill health by offering employees access to services such as:

Crisis counselling
Psychological and social counselling
Financial counselling
Legal advice
Etc…

All services provided are confidentially administered with the employer never knowing that such services were utilized.

Choose A Plan Today

Set up an Association Benefits Plan by contacting us to discuss how.

Set up A Custom Benefits Plan for your Company by using our online form.