Question 1

What is covered under my group benefits?

Accepted Answer

Coverage varies by plan, insurer, and employer. Employees can confirm their coverage by reviewing the employee benefits booklet provided by the insurer or provider, or by contacting them directly for specific eligibility, limits, and claim details.If we are your benefits consultant, employees should also have access to the Employee Benefits Summary designed to make the plan easier to understand. It highlights the benefits employees typically ask about most, summarizes key coverage information, and provides important links, contact details, and access information in one convenient resource. As a summary resource, the insurer’s booklet and policy remain the governing sources for coverage details.Should you wish to access this resource, please contact your employer directly.

Question 2

Why wasn’t my health or dental claim fully paid?

Accepted Answer

Your claim may not be fully reimbursed for several possible reasons:Eligibility & Timing: Waiting periods, benefit years, or claim submission deadlines may affect payment.Coverage Exclusions: The service, treatment, drug, supply, or procedure may not be covered or may be specifically excluded.Coverage Limits: The plan may only reimburse a percentage, apply a deductible, or limit coverage by frequency.Charge Limits: Fee guides, R&C & dispensing limits, generic pricing, or alternate-benefit provisions may reduce reimbursement.Approval Requirements: Referrals, prior or special authorization, medical necessity, or step therapy may be required.Coordination of Benefits: Another plan may need to pay first, with the remaining eligible balance submitted afterward.Documentation: Missing receipts or information, incorrect details, or insufficient documentation may affect processing.Processing Issues: Duplicate claims, billing errors, or insurer processing errors may require review or resubmission.Start by reviewing the insurer’s Explanation of Benefits (EOB) or the provider's Claim Statement, which should show what was paid and why any portion was declined or reduced. If the reason is unclear, contact the insurance company or provider directly - they can explain how the claim was assessed and whether additional information or a resubmission is required.If we are your benefits consultant and you are having difficulty resolving the issue with the insurer or provider, you are welcome to contact us directly. With your written consent, we can escalate the matter with the insurer or provider and keep you informed. To protect the confidentiality of your personal health information, we recommend contacting us directly. Claim details are handled confidentially and are not shared with your employer as part of our assistance, unless you provide prior written consent.

Question 3

How does coordination of benefits work?

Accepted Answer

Coordination of benefits applies when you or your eligible dependants are covered under more than one benefits plan. It determines the order in which claims should be submitted so each plan can assess its portion of the eligible expense.The claim is submitted to the primary plan first. Any remaining eligible balance can then be submitted to the secondary plan, together with the first plan’s Explanation of Benefits (EOB). Total reimbursement cannot exceed the eligible expense. If a Health Care Spending Account is available, any remaining eligible balance may be submitted after all insured coverage has been coordinated.COORDINATION OF BENEFITS SEQUENCE:

Question 4

How do I track my life & living benefits coverage?

Accepted Answer

It is a good idea to periodically review and track your life and living benefits coverage. Group benefit plans provide valuable protection, but they may not address every personal financial risk or obligation. For this reason, some individuals also maintain personal insurance coverage alongside the protection available through work.Coverage needs can also change over time. Changes in income, employment, family circumstances, dependants, debt, or other financial responsibilities can affect the amount and type of protection you may need. Group benefits plan coverage can also change when you change jobs, your earnings change, or your employer modifies its program. Keeping a clear record of both group and personal coverage makes it easier to understand what you currently have and identify when a review may be appropriate.INSURANCE TRACKERDOWNLOADA simple tool to help you organize and track your life & living benefits coverage in one place. Once completed, consider keeping:an electronic copy that can be easily updated whenever coverage changes; anda printed copy with your insurance documents so the information is readily available if required.Disclaimer: This resource is provided for organizational purposes only. It does not constitute insurance, investment, financial, legal, tax, or other professional advice, and no result or outcome is guaranteed. EBC’s downloadable resources are intended to be saved and used on your own device; information you enter into them is not submitted to or stored by EBC. Please verify information and seek appropriate professional advice before making any decisions.

Question 5

What is a beneficiary?

Accepted Answer

The person, people, or entity (“Beneficiary”) you designate to receive an eligible death benefit under your group benefits plan. You may name more than one Beneficiary and assign a percentage to each, provided the total allocation equals 100%. Beneficiary designations should be reviewed periodically, particularly after major life events.Primary: The Beneficiary first entitled to receive the death benefit.Contingent: The Beneficiary that receives the death benefit if no Primary Beneficiary survives you. This helps avoid delays or complications in directing the proceeds.Minor Beneficiary: A child under the age of majority, but special rules apply to how the proceeds are paid.Trustee: A person appointed to receive and manage the proceeds on behalf of a minor beneficiary. They are not a beneficiary.Entity Beneficiary: A non-individual beneficiary, such as a charity, trust, corporation, institution, or estate.Estate Beneficiary: If designated or no eligible beneficiary remains, the death benefit may be payable to your estate.Revocable Beneficiary: A designation you can generally change without obtaining the beneficiary’s permission.Irrevocable Beneficiary: A designation that generally cannot be changed without the beneficiary’s written consent.IMPORTANT: Beneficiary designations do not necessarily update automatically after marriage, separation, divorce, or other life changes. Review and update your designation directly with the insurer when circumstances change. Employees can use the insurer’s beneficiary designation form or online portal and should seek appropriate professional advice where needed.

Employers offer this to ensure their people have access to the medical services and products they need - reducing financial stress, supporting overall health, and demonstrating a genuine commitment to employee wellbeing.

Employers offer this because oral health is an essential part of overall health - and ensuring employees can access routine and unexpected dental care without financial burden reflects a genuine commitment to their people's health.

Employers offer this because a serious diagnosis should never also mean a financial crisis - giving employees the freedom to focus entirely on their recovery without the added burden of lost income or mounting expenses.

Employers offer this to give employees peace of mind that the people who depend on them will be financially protected - with easier access and more affordable coverage than what may be available on an individual basis.

Employers offer this to ensure their people have a dedicated layer of financial protection specifically for accidental death and covered serious injuries - coverage that responds directly to the unexpected, life-altering events.

Employers offer this to protect their people's income when illness or injury prevents them from working - ensuring financial stability whether the absence is temporary or long-term.

Employers offer this because employees bring their whole lives to work - providing confidential, professional support that helps them navigate challenges, strengthen wellbeing, and are more present and resilient at work.

Employers offer this to give their people fast, convenient access to healthcare professionals without the wait - supporting employee health and reducing the productivity loss that comes with time away from work.

Employers offer this because a diagnosis or treatment plan should never leave an employee with doubt - giving their people access to independent expert review ensures they make informed decisions about their health and care.

What are group benefits?

Why offer group benefits?

How much do group benefits cost?

How often should a benefits plan be marketed?

What’s best, benefits or spending accounts?

What is covered under my group benefits?

Why wasn’t my health or dental claim fully paid?

How does coordination of benefits work?

How do I track my life & living benefits coverage?

What is a beneficiary?

​​Employers offer this to ensure their people have access to the medical services and products they need - reducing financial stress, supporting overall health, and demonstrating a genuine commitment to employee wellbeing.

​​​Employers offer this because oral health is an essential part of overall health - and ensuring employees can access routine and unexpected dental care without financial burden reflects a genuine commitment to their people's health.

​​Employers offer this because a serious diagnosis should never also mean a financial crisis - giving employees the freedom to focus entirely on their recovery without the added burden of lost income or mounting expenses.

​​Employers offer this to give employees peace of mind that the people who depend on them will be financially protected - with easier access and more affordable coverage than what may be available on an individual basis.

​​​Employers offer this to ensure their people have a dedicated layer of financial protection specifically for accidental death and covered serious injuries - coverage that responds directly to the unexpected, life-altering events.

​

​Employers offer this to protect their people's income when illness or injury prevents them from working - ensuring financial stability whether the absence is temporary or long-term.

Employers offer this because employees bring their whole lives to work - providing confidential, professional support that helps them navigate challenges, strengthen wellbeing, and are more present and resilient at work.

​Employers offer this to give their people fast, convenient access to healthcare professionals without the wait - supporting employee health and reducing the productivity loss that comes with time away from work.

Employers offer this because a diagnosis or treatment plan should never leave an employee with doubt - giving their people access to independent expert review ensures they make informed decisions about their health and care.

What are group benefits?

Why offer group benefits?

How much do group benefits cost?

How often should a benefits plan be marketed?

What’s best, benefits or spending accounts?

What is covered under my group benefits?

Why wasn’t my health or dental claim fully paid?

How does coordination of benefits work?

How do I track my life & living benefits coverage?

What is a beneficiary?

Employers offer this to ensure their people have access to the medical services and products they need - reducing financial stress, supporting overall health, and demonstrating a genuine commitment to employee wellbeing.

Employers offer this because oral health is an essential part of overall health - and ensuring employees can access routine and unexpected dental care without financial burden reflects a genuine commitment to their people's health.

Employers offer this because a serious diagnosis should never also mean a financial crisis - giving employees the freedom to focus entirely on their recovery without the added burden of lost income or mounting expenses.

Employers offer this to give employees peace of mind that the people who depend on them will be financially protected - with easier access and more affordable coverage than what may be available on an individual basis.

Employers offer this to ensure their people have a dedicated layer of financial protection specifically for accidental death and covered serious injuries - coverage that responds directly to the unexpected, life-altering events.

Employers offer this to protect their people's income when illness or injury prevents them from working - ensuring financial stability whether the absence is temporary or long-term.

Employers offer this to give their people fast, convenient access to healthcare professionals without the wait - supporting employee health and reducing the productivity loss that comes with time away from work.