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Physiotherapist Lalitha McSorley works on a patient while wearing her personal protective equipment at the Brentwood Physiotherapy Therapy clinic in Calgary, on June 5, 2020.

Todd Korol/The Globe and Mail

Back in March, COVID-19 forced dentists and other health care providers, such as physiotherapists, massage therapists and acupuncturists, to close their doors. That meant Canadians with benefits were blocked from any in-person routine visits to these providers.

Some Canadian insurance companies have responded to the pandemic shutdowns by offering temporary reductions to the premiums that plan sponsors pay, for both group benefits and individual health plans.

But the relief varies by insurance companies and plans, making it more important than ever for consumers to understand their benefits: what they’re getting, who’s paying what, how long they have to use the services, etc.

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John Bascom, an independent insurance broker and owner of J.P. Bascom Insurance, has spent more than 40 years working in the insurance industry, focused on group benefit plans. He says the insurance industry’s response to COVID-19 has been unprecedented.

All the insurance companies he works with have introduced temporary premium reductions, he says, meaning workers or their employers won’t be forced to pay for services they can’t use. If the plan is structured so that employees pay only a portion of the premium, they could see some savings, too.

In Canada, the cost of dental, eye care or extended health is paid for through private health insurance. People get health insurance through group benefit plans, often provided by employers, unions or professional associations, or through an individual plan that they buy on their own.

Insurance premiums pay for these plans. For group benefits, some employers foot the entire bill for premiums, while others split the cost with employees. But not everyone is getting relief.

Sun Life Financial, for example, did not offer reductions in premiums to people with personal health insurance plans.

Employers with non-refund group plans are receiving a 50 per cent credit per month against dental premiums and a 20 per cent credit for non-drug-related extended health care premiums, which Sun Life says works out to about 8 to 9 per cent of the overall extended health care premium.

“We put the credit in place for April and that shows up on their June invoice. It’s in place for May and that shows up on their July invoice,” says Dave Jones, senior vice-president of group benefits for Sun Life Financial Canada.

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No such credits are given for personal plans because of their different structure and level of flexibility, though clients are given more time to pay their premiums, he says.

Since providers are beginning to open back up and claims are starting to flow, Mr. Jones says the company is now figuring out what credit level it will offer for the month of June. In April and May, the premium reductions meant an average credit of about $56 a member per month.

For plans where an employee pays part of the premium, Mr. Jones says it’s up to the employer to pass on those savings. He’s seen a varied response, with some employers providing a reduction to employees now, while other employers plan to use the credit to reduce the future cost of benefits, or, in some cases, add certain coverage.

If there is a second wave of COVID-19 and another shutdown of services, Mr. Jones says Sun Life is prepared to reinstate credits on premiums.

Other insurance companies are structuring premium reductions differently. Green Shield Canada’s premium reductions apply for April, May and June, with a 75-per-cent reduction in dental rates and a 20-per-cent reduction in health rates, excluding drugs. Desjardins Insurance, meanwhile, has not announced any premium discounts, credits or extensions on dental or other health benefits.

At a time when COVID has shattered the job market and left many unemployed or underemployed, no one wants to be paying for benefits they can’t use. Some experts are questioning whether the response from insurance companies goes far enough.

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“For many employees, the lost opportunity cost on using those benefits is much more than some savings for a few months on the premium,” says Rona Birenbaum, founder of Caring for Clients, a financial planning firm.

She anticipates some people could find themselves going over claim limits if they’re making up for visits that couldn’t happen for a few months because of closings. To that end, she recommends people understand what their plan covers. In her mind, benefits are an “underrecognized form of total compensation.”

Benefits cost an average of $9,011 per full-time equivalent employee, according to 2019 figures from the Conference Board of Canada.

Nick Gubbay is a principal in the group benefits practice of actuarial consultant Eckler, which consults with about 100 group benefit plan sponsors across Canada, including companies, provincial and municipal governments and unions.

He says the value of dental claims paid in March, compared with February, dropped by about 25 per cent to 30 per cent; in April the month-over-month decline was 80 per cent to 90 per cent.

On the extended health benefits side, there was a 5-per-cent increase in claims in March, relative to February, and about a 40-per-cent decrease in April, relative to March.

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With people unable to see physiotherapists, massage therapists, chiropractors and other providers, Mr. Gubbay adds that insurance companies have responded with greater flexibility in accepting claims for virtual treatments (for physio, for example), where possible.

“With the pandemic arising, this really has led to rapid adoption of these services by many more insurers and by plan sponsors,” he says.

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