10 Things You Should Expect from Your Group Benefits Advisor

Whether you’re starting a new employee benefit plan or you already have one – you want to get the best value for your money.

An important part of making that happens is working with an employee benefits specialist.

But what makes for a great group benefits advisor? And what exactly should your advisor be doing to support you?

In this article, we’ll cover the 10 main responsibilities of a group benefits advisor to help you determine whether you’re getting the service and support you deserve.

Group benefits advisors should be ready to help their clients in the following ways.

1. Create a benefits plan that’s right for your company

2. Train and support your plan administrator

3. Promote the benefits plan to your employees

4. Keep your plan on track with an Annual Review

5. Be available to answer your questions

6. Help with major claims

7. Get involved when problem surface

8. Keep you informed about changes that affect your plan, including new plan options

9. Help you avoid the potential liabilities associated with benefits plans

10. Ensure that your costs are always competitive and fair

The role of a group benefits advisor goes beyond just selling a plan and delivering a renewal every year. Working with someone who specializes in employee benefits makes all the difference and can help you avoid unnecessary frustration. To learn more, keep reading.

1. Create a benefits plan that’s right for your company

Just as it would be unwise to accept a prescription from a doctor who has not taken the time to ask questions and understand your needs, it is also unwise to seek benefits advice from a broker who has not taken the time to learn about your company. Without this understanding, it is unlikely that the broker will be able to recommend the best options for your business.

The best benefits advisors take the time to understand the needs of each business and the people within it.

Some examples of questions that a benefits advisor might ask include:

• What objectives are you trying to accomplish with your benefit plan? E.g. Attract better employees? Reduce employee turnover?
• Have you surveyed your employees recently to find out what’s important to them?
• What’s working well with your current plan? What’s causing you frustration? What kind of comments have you received from employees about your current plan or insurer?
• How competitive is the labour market in your industry currently?
• What is your ideal budget to spend on employee benefits? Are your current benefits costs in line with employee wages?
• Do you know how your plan compares with those of similar companies in your area or industry?
• When was the last time your plan was marketed to see whether your pricing was competitive?

By asking the right questions, benefits advisors can help build the right plan for you and your team.

2. Train and support your Plan Administrator

Most benefits plan administrators have more than one role within their company. The job of overseeing Employee Benefits is often given to the HR Manager, Office Manager, Payroll Specialist or even the business owner themselves.

This means that you’re already extremely busy and may not have the time to be a group benefits expert.

Since insurance companies offer limited support to Plan Administrators, a benefits advisor should be the primary source of training and support.

Below are some of the ways in which Benefits brokers can provide training to Plan Administrators:

• How to enrol employees properly and avoid Late Applicant situations
• How to calculate and set up payroll deductions properly (including taxable benefits)
• How to use the Plan Administrator website for enrolling and terminating employees, updating employee details, updating incomes, accessing reports, etc.
• How to conduct group benefits orientations for new employees, including giving an overview of the benefits package and explaining their options to them
• How to use the Plan Member website so that you can promote it and encourage your employees to use it
• How to answer some of the most common questions that employees ask about benefits

3. Promote the benefits plan to your employees

Unfortunately, most employees don’t have a good understanding of what’s included in their own group benefits plan.

Considering that group benefits plans are a significant expense for most businesses, this lack of understanding means that employers aren’t taking full advantage of their group benefits expenditures.

Employees will usually turn to their benefits booklet provided by the insurance company. However, these booklets can be difficult to understand.

Employees who don’t understand their benefit plan aren’t likely to appreciate it.

The reality is that it’s impossible for employees to place value on a benefit that they don’t know very much about. Your group benefits advisor should be available to help your employees understand:

✓ What’s covered by the plan

✓ How to submit different types of claims

✓ What to do when they encounter a problem or have a claim declined

✓ How to save money on health & dental purchases

✓ What kinds of personal changes their Plan Administrator needs to be made aware of

✓ Answers to frequently asked questions about topics like travel insurance and coordinating multiple plans

How does an advisor help your staff understand and appreciate the benefits you provide? A good benefits advisor can facilitate employee meetings and provide you with written employee communications that can be forwarded to your employees.

4. Keep your plan on track with an Annual Review

To help keep your benefits plan operating smoothly, it’s important that your advisor review certain aspects of your plan with you each year. This ensures that your plan remains healthy and operates efficiently. It also helps you avoid many of the common mistakes and pitfalls that you may not be aware of.

A few examples of the areas to review are:

Income Updates: does the insurer have the current earnings for your employees?

No Evidence Maximums: will the insurer allow the limits (for life insurance, disability, and critical illness) to be raised for the whole group?

Under-insured Employees: are there any under-insured employees? If so, are they aware that they are underinsured? If they’ve chosen not to apply for the excess coverage, have they signed a waiver that verifies it is their decision to do nothing?

Signed Waivers: are there any eligible employees who are not participating? If so, have they signed a waiver indicating that it was their decision to not enrol?

Other Benefits Options: would you like information about any benefits that are not included in your current plan? (For example, Employee Assistance Plans, Critical Illness, Health Spending Accounts, Wellness Accounts, etc.)

Training & Support: do you need assistance with Plan Administrator training? Do you need specific employee communications?

Maintaining a healthy employee benefits plan requires doing several important tasks on a regular basis. An Annual Review will help you avoid unwanted problems and allow your plan to function at its best.

5. Be available to answer your questions

For anyone who has worked with a good employee benefits advisor, it might seem obvious that the advisor needs to be available to answer questions. However, I’m continually surprised by how many companies have been told by their insurance agents to “just call the insurance company” when the client has questions or needs help. These agents either don’t have the knowledge to help or, even worse, don’t believe this is part of their job.

An experienced, professional group benefits advisor will always be able to answer your questions and offer you the support you need.

6. Help with major claims

If you have a benefits plan for long enough, your employees will have disability, critical illness claims or even life insurance claims. These kinds of claims involve large payouts, distressed employees and paperwork that needs to be done correctly.

Ensuring that these claims are handled properly and that the payments are received quickly is very important.

A good benefits advisor will be involved from the beginning to make sure the process goes smoothly. And in the event that the claim is unexpectedly denied, it’s the job of the benefits advisor to investigate and help file an appeal when necessary.

7. Get involved when problems surface

Even the best Plan Administrators encounter problems with their group benefits plan from time to time.

Despite making every effort, it’s inevitable that any Plan Administrator can face challenges such as:

• Late Applicants (employees who don’t enroll on time)
• declined claims (including health, dental & disability claims)
• upset or uncooperative employees
• questions from employees or their spouses
• administrative errors

A good benefits advisor will be able to help you navigate through each of these challenges as they arise. Most of the time, the advisor should be able to correct the problem for you.

8. Keep you informed about changes that affect your plan, including new plan options

When provincial and federal governments make changes to tax laws or programs like EI and CPP, there is often a direct impact on employee benefits plans.

It is the job of the group benefits advisor to stay informed about these changes so that they can pass them along to their clients.

Sometimes these changes mean that you need to make adjustments to your benefits plan. For example, in 2017, the waiting period for EI Sickness benefits was shortened from 2 weeks to 1 week. This meant that many Long Term Disability (LTD) plans needed to have their waiting periods shortened by 1 week as well (from 119 days to 112 days). Otherwise, employees who transitioned from the EI benefit to an LTD benefit would not receive any payments from either program during the 7 days after EI coverage ended but before LTD coverage began.

The last 10 to 15 years have seen many changes which affect employee benefits. These include privacy laws, how employer-paid benefits are taxed, the introduction of technology such as phone apps and plan member websites, mainstream acceptance of medical cannabis, high-cost biologic prescription drugs, the introduction of a dental fee guide in Alberta, an increase in the importance of mental health and many more.

Additionally, as new group benefits products and options become available, it is the job of the group benefits advisor to let their clients know. Insurance companies are beginning to innovate at a faster rate than ever before and it’s important that small businesses are made aware of what’s available.

9. Help you avoid the potential liabilities associated with benefits plans

One of the most important responsibilities of a group benefits advisor is to help their clients avoid the typical mistakes that wind up getting the employer into trouble.

Some examples of these pitfalls include:

Late Applicants: the advisor should help set up a process to avoid having employees apply for benefits as Late Applicants

Signed Waivers for Non-participating Employees: if the employer allows an employee to fully opt out of the benefits plan, it is important that the employee sign a written waiver, acknowledging that the employee benefits were offered to them, but they personally chose to participate. This way, if the employee becomes disabled, dies or suffers a serious medical condition, they cannot try to hold the employer responsible for the lack of insurance coverage.

Signed Waivers for Under-Insured Employees: when an employee is eligible to apply for life insurance, disability or critical illness coverage in excess of the No Evidence Limit, they have the option of completing a medical questionnaire and applying for the additional coverage. If they choose not to apply, they will remain at their current level of coverage and will be underinsured based on their earnings. If an employee dies, becomes disabled or is diagnosed with a critical illness, being under-insured means that they (or their beneficiary in the case of life insurance) will receive less of a payout than expected. If this happens, the employer needs to have proof that the affected employee was made aware that they were under-insured and that it was their decision not to apply for the additional coverage.

Written Policy concerning Benefits for Disabled Employees: when an employee becomes disabled and can no longer come to work, how long should they be able to remain on the company benefits plan? The company’s written policy & procedures manual should address these types of situations. By doing this, the company will avoid accusations of discrimination when the benefits are ended.

Independent Contractors: do you have Independent Contractors participating in your benefits plan? If so, are any of their benefits, such as disability coverage, based on employment income? Permitting situations like this increases the likelihood that CRA might challenge the self-employed status of the contractors.

These and other potential hazards can be avoided with the guidance of an experienced, professional benefits advisor.

10. Ensure that your costs are always competitive and fair

Without the help of an experienced advisor, it is difficult to determine whether the cost of a benefits plan is competitive and fair. This is because there are too many factors that determine the price such as:

• the ages of the employees
• the ratio of males to females
• the industry
• the occupations of the employees
• the total number of employees
• the claims history
• the plan design

Any single one of these factors can have a significant impact on the cost of a benefits plan.

For this reason, businesses must rely on their benefits advisor to regularly monitor the cost of their benefits plan. And when the costs start to become uncompetitive, the advisor’s job is to offer affordable solutions.