New Insurance Programs from OPA

Insurance is a form of investment. It’s a way to hedge your bets, because there are some gambles you can’t opt out of; from the inherent risks of driving a car, to health risks based on the genes you inherited. Mitigating the risk of a loss is what gave way to the evolution of insurance. Anyone who has ever had the need to access their benefits understands the importance of having insurance coverage.  Whether it was a result of a disability, car accident or a diagnosis requiring lifelong treatment, without having proper insurance in place the results would be catastrophic.

Below are two new insurance plans for members to ensure protection keeps up with industry trends:

Your new OPA Secure Health Plan explained

The OPA Secure Health Plan is made available to all OPA members as a tool to help protect you and your family from unforeseen medical expenses. We currently have a substantial portion of the membership participating in the current plan, and starting July 1, 2018 all members have a renewed opportunity to benefit from such protection.

Table of Benefits

What is changing?

There are two major changes taking place effective July 1, 2018:

  1. Annual deductibles are being introduced
    • Prescription Drug deductible of $1,000 per single/family per calendar year
    • Combined $300 Health and Dental deductible per single/family per calendar year
  2. Prescription Drug coverage has been integrated into the OPA Secure Health Care Plan

    The new OPA Secure Health Plan ensures that members have access to coverage that will protect them financially in case of catastrophic medical expenses by:

    • Keeping the plan viable long-term by allowing members to be “self-insured” the first $1,000 per family of Prescription Drug expenses, and the first $300 per family of Health and Dental expenses
    • Providing a comprehensive catastrophic coverage package for expenses beyond the deductibles at a fair and reasonable price to all members

What is not changing?

Beyond the changes described above, coverage, co-insurance and maximums of all benefits available under the current OPA Secure Health Plan will remain the same.

The new OPA Secure Health Plan will also continue to include Life, Dependent Life, AD&D and Travel Insurance coverage. 

For a schedule of the benefits, current and new, please see the Table of Benefits. In addition, the Optional Life, Optional AD&D and Optional Critical Illness remain in place and available to members at any time. Details on these optional plans can be located at OPA's insurance section:

Are there any changes to the premium?

Yes, the premium for the new plan effective July 1, 2018 will change. The change will depend on your current coverage. For a view of the new premium schedule, please see the Table of Benefits.

If you are currently participating in the plan, you will receive further details of the change in premium that is applicable to you through the plan administrator, Maximum Benefit, when you receive your billing for the month of May.

As a member currently participating in the plan, do I need to do anything?

You are not required to do anything. Closer to the change date you will receive a confirmation of your new monthly premium on your billing from Maximum Benefit, your plan administrator. We encourage you to contact OPA with any questions regarding your coverage and premium. 

What happens to previously approved pre-determinations?

If you have already received approval on a pre-determined treatment plan, it will continue to be honoured based on the coverage in place at the time of the approval. 

What happens to our current maximums and current balances on the maximums?

The maximums on the benefits will refresh for the July 1 effective date. Please note, however, that all maximums and deductibles will be pro-rated for the six-month period from July 1 to December 31, 2018. Not all maximums will be prorated.

On January 1, 2019 all deductibles and maximums will be refreshed in full. 

What are my options if I no longer want to participate in the plan?

You have the option to cease coverage if you so choose. Please contact OPA for details if you no longer want coverage under the plan. 

Why should I participate in this plan?

Coverage for health and dental expenses come in many different sizes variations, both in terms of coverage and cost. The choices are there, and it’s up to you to decide which option suits you best. OPA’s intent is to make available a plan that will be there for our members when they need it the most — a time when some plans may no longer provide the coverage you need.

According to the Canadian Institute for Health Information study conducted in 2016, health spending in Canada was projected to reach $228.1 billion, which averages to about $6,299 per Canadian1. The study continues to say that 70% of this amount is paid for through public funding, which leaves the remainder to be paid by private insurance (12%), by Canadians themselves (out-of-pocket 15%), or through other sources of funding (3%). This means that the average Canadian can expect to spend roughly $1,701 per year in healthcare expenses, with about $945 of this amount remaining out-of-pocket. Keep in mind this cost is per individual – not family. Multiply this times by the number of people in your family, and keepkeeping in mind that this is an average expense, and you could be looking at significantly higher costs.

1 National Health Expenditure Trends, 1975 to 2016 (CIHI)

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Attention Incorporated Pharmacy Owners

A Plan for You and All Your Employees: OPA Advantage Plus

In the fall 2017 edition of Ontario Pharmacist we introduced a concept in insurance that is gaining ground with many employers looking to provide some level of benefits to their employees without breaking the bank. Please click here to review the article. Health Care Spending Accounts, or HSAs as they are best known, have been around for some time now, however in most recent years there has been an increase in health plans that include an HSA as part of their commitment to the health and welfare of their employees. As an employer, your maximum cost is known upfront and does not vary, making budgeting easier. Your employees can use the dollars allocated to them as they see fit, as long as the expenses are deemed medical expenses eligible under the list provided by the Canada Revenue Agency, for the purpose of income tax credit.

Effective July 1, 2018, if you’re an owner of an incorporated pharmacy, you will be able to offer a HSA plan with a $2,000 benefit to your employees. In order to offer this plan you must have at least one employee working for you (who is not related to you), and all employees of the same class must be part of the plan.

Not Just an HSA Benefit

To complement the HSA Benefit, OPA has also arranged for additional coverage for further protection for you and your employees, similar to those included in the current OPA Secure Health Plan:

  • Life Insurance, Dependent Life Insurance and Accidental Death Insurance;

  • 120-day Out-of-Province/Country Emergency Medical Insurance and Travel Assistance; and

  • Prescription Drug Insurance, for expenses exceeding $2,000 per family per year.

The Prescription Drug Insurance takes away the financial risk from the owner/operator of a pharmacy – for employees and owners. The insured Prescription Drug Plan is priced based on a $2,000 deductible, which translates into an affordable way to protect against the financial risk associated with higher cost medications.

Table of Benefits

I am a pharmacy owner. When can I register my business for the OPA Advantage Plus?

The incorporated pharmacy plan will launch July 1, 2018. To meet this date, the plan administrator, Maximum Benefit, will require that you register and supply the required employee information 45 days in advance of the effective date. Your pharmacy must qualify to register for this plan. To qualify, your business must be incorporated and you must have at least one employee at arm’s length (not related to you or living in your household). Once qualified you will be required to complete an HSA Agreement Form. This form is available on the OPA website.

Do I have to provide this coverage to all employees?

No, but you must cover all employees of the same classification of employees. Employees who have coverage through a spouse can opt out of the insured portion of this plan, however they would still be entitled to receive the benefit of the HSA coverage.

Who pays the premium?

The insured portion of the plan can either be paid by the employee, the employer or shared by both. While the benefit provided through an HSA is well defined at the time of the offer – in the case of this plan, $2,000 per family per year – the cost to the sponsoring employer will be defined based on claims paid plus expenses of paying such claims. In any event, it must be paid by the employer. Please note however, that your cost limit is known up front, which is an advantage for budgeting purposes.

Are the costs of an HSA plan tax deductible as business expenses?

Yes. As the sponsoring employer, you are able to deduct all costs associated with providing the HSA benefit to your employees. In addition, the benefit received by your employees is tax free in their hands. 

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