Employee Benefits
Employee Group Benefits
Employee Group Benefits
At Wilman Financial Inc., employee benefit plans are our specific area of expertise. Our comprehensive resources and passionate devotion to plan design and management has allowed us to devise the most innovative solutions and competitive group quotes in the industry. Our friendly staff seeks to provide the highest level of service in helping your company come up with a highly personalized and effective group plan.
Health Benefits
- Prescription Drugs
- Hospital
- Supplementary Health
- Vision Care
- Out of Province / Country Emergency Travel
Dental Benefits
- Basic
- Extensive
- Orthodontic
Life Benefits
- Basic Life
- Accidental Death and Dismemberment
- Optional Life
- Optional Accidental Death and Dismemberment
Disability Benefits
- Short Term Disability
- Long Term Disability
Health Benefits
| Payment basis: | Direct payment or reimbursement |
| Benefit payment: | 70-100% – Usually including a dispensing fee |
| Eligible drugs: | Drugs requiring a prescription by provincial or federal law, selected over the counter products could be included |
| Least cost alternative pricing: | Some plans pay for generic drug cost only, if available |
| Allergy serums: | Included |
| Contraceptive drugs: | Drugs with a duration of action greater than 100 days usually have a limited amount per participant in a 60 month period |
| Smoking cessation products: | Fixed lifetime amount per participant |
| Vaccines: | Fixed amount per participant each benefit year |
* Selected drugs may be considered for coverage through a special authorization process.
| Benefit payment: | 100% |
| Private/semi-private rooms: | Direct payment or reimbursement |
| Auxiliary care: | $200-$500 per participant each benefit year |
| Outpatient expenses: | Out of province |
Long-term care insurance helps cover costs associated with long-term care for those not covered by health insurance. The intention is to provide the very best in long-term care. Without insurance the costs of such arrangements can easily run in the thousands of dollars every month.
Benefits can be provided for:
✓ Home health care
✓ Chronic-care (such as a continuing care centre or nursing home)
✓ Medical equipment
✓ Respite care
✓ Hospice care
✓ Adult day care
Supplementary Health BenefitsAccidental dental |
Medical aids: Medical care (outside Canada) |
| Benefit payment: | Usually 100% |
| Maximum: | $200-$600 per participant each benefit period |
| Benefit period: | Adult 24 consecutive months Child 12 consecutive months |
| Eligible benefits: | Contact lenses Eye glasses (frames and/or lenses) Intraocular lenses Laser eye surgery, including assessment fees |
| Exclusions: | Industrial safety glasses Sunglasses Eye examinations – usually included in supplementary health |
Out of Province / Country Emergency Travel Benefits
Benefits are provided as a result of a medical emergency which occurs outside the Participant’s province of residence.
| Benefit period: | Usually 30 Days |
| Maximum: | $1,000,000 up to an unlimited amount in Canadian funds per participant per incident |
| Accidental dental: | Usually $2,000 per participant per accident to natural teeth |
| Air ambulance | |
| Ambulance services | |
| Cremation or burial | |
| Dental pain relief: | Fixed amount per participant per trip |
| Diagnostic services: | Laboratory services, x-rays, blood and blood plasma |
| Drugs: | Included |
| Expenses to visit the covered person: | Transportation Meals/accommodation |
| Hospital accommodation | |
| Incidental expenses | |
| Meals and accommodations | |
| Medical aids: | Casts, canes Crutches, slings Splints, trusses Temporary wheelchair Rental, walkers |
| Medical evacuation: | Air ambulance Repatriation |
| Nursing care | |
| Outpatient expenses | |
| Paramedical practitioners: | Chiropractor Chiropodist/podiatrist Physiotherapist |
| Physicians and surgeons fees | |
| Return of deceased | |
| Travel assistance | |
| Vehicle services |
Prescription Drug Benefits
| Payment basis: | Direct payment or reimbursement |
| Benefit payment: | 70-100% – Usually including a dispensing fee |
| Eligible drugs: | Drugs requiring a prescription by provincial or federal law, selected over the counter products could be included |
| Least cost alternative pricing: | Some plans pay for generic drug cost only, if available |
| Allergy serums: | Included |
| Contraceptive drugs: | Drugs with a duration of action greater than 100 days usually have a limited amount per participant in a 60 month period |
| Smoking cessation products: | Fixed lifetime amount per participant |
| Vaccines: | Fixed amount per participant each benefit year |
* Selected drugs may be considered for coverage through a special authorization process.
Hospital Benefits
| Benefit payment: | 100% |
| Private/semi-private rooms: | Direct payment or reimbursement |
| Auxiliary care: | $200-$500 per participant each benefit year |
| Outpatient expenses: | Out of province |
Long Term Care Insurance
Long-term care insurance helps cover costs associated with long-term care for those not covered by health insurance. The intention is to provide the very best in long-term care. Without insurance the costs of such arrangements can easily run in the thousands of dollars every month.
Benefits can be provided for:
✓ Home health care
✓ Chronic-care (such as a continuing care centre or nursing home)
✓ Medical equipment
✓ Respite care
✓ Hospice care
✓ Adult day care
Supplementary Health BenefitsAccidental dental |
Medical aids: Medical care (outside Canada) |
Vision Care
| Benefit payment: | Usually 100% |
| Maximum: | $200-$600 per participant each benefit period |
| Benefit period: | Adult 24 consecutive months Child 12 consecutive months |
| Eligible benefits: | Contact lenses Eye glasses (frames and/or lenses) Intraocular lenses Laser eye surgery, including assessment fees |
| Exclusions: | Industrial safety glasses Sunglasses Eye examinations – usually included in supplementary health |
Out of Province / Country Emergency Travel Benefits
Benefits are provided as a result of a medical emergency which occurs outside the Participant’s province of residence.
| Benefit period: | Usually 30 Days |
| Maximum: | $1,000,000 up to an unlimited amount in Canadian funds per participant per incident |
| Accidental dental: | Usually $2,000 per participant per accident to natural teeth |
| Air ambulance | |
| Ambulance services | |
| Cremation or burial | |
| Dental pain relief: | Fixed amount per participant per trip |
| Diagnostic services: | Laboratory services, x-rays, blood and blood plasma |
| Drugs: | Included |
| Expenses to visit the covered person: | Transportation Meals/accommodation |
| Hospital accommodation | |
| Incidental expenses | |
| Meals and accommodations | |
| Medical aids: | Casts, canes Crutches, slings Splints, trusses Temporary wheelchair Rental, walkers |
| Medical evacuation: | Air ambulance Repatriation |
| Nursing care | |
| Outpatient expenses | |
| Paramedical practitioners: | Chiropractor Chiropodist/podiatrist Physiotherapist |
| Physicians and surgeons fees | |
| Return of deceased | |
| Travel assistance | |
| Vehicle services |
Dental Benefits
Benefit payment – 70-100%:
Diagnostic services:
Complete oral exam
Recall or limited oral exam
Bitewing radiographs
Specific oral exam
Emergency exams
Complete series/panoramic radiographs
Consultations
Preventive services:
Polishing
Scaling and root planing
Fluoride treatment
Pit and fissure sealant
Space maintainers
Benefit Payment – 50-80%
Restorative services:
Restorations
Oral surgery:
General surgery exam
General anesthesia
Endodontics:
Endodontic exam
Root canal therapy
Apicoectomy
Retrofill
Pulpectomy
Pulpotomy
Periodontics:
Surgical:
Periodontic surgery osseous surgery
Osseous grafts
Soft tissue grafts
Non-surgical:
Provisional splinting
Scaling and root planing
Management of oral infections
Prosthodontic appliances (limited to one of the following services per tooth):
Crowns
Fixed bridges
Inlays and onlays
Processed veneers
Posts & cores
Partial dentures
Removable appliances:
Complete dentures
Denture services:
Rebasing and resetting
Adjustments
Relines
Liners
Tissue conditioning
Repairs
Provision for implants
Benefit payment: 50%
Maximum: $2,000 – $4000 lifetime amount per participant
Diagnostic services:
General orthodontic exam
Cephalograms
Facial/intraoral photographs diagnostic models
Consultation and case presentation
Habit-breaking appliances
Interceptive, interventive, preventive:
Fixed and removable appliances functional appliance therapy formal banding treatment
Pre-authorization:
Usually required for a treatment plan
Basic Dental
Benefit payment – 70-100%:
Diagnostic services:
Complete oral exam
Recall or limited oral exam
Bitewing radiographs
Specific oral exam
Emergency exams
Complete series/panoramic radiographs
Consultations
Preventive services:
Polishing
Scaling and root planing
Fluoride treatment
Pit and fissure sealant
Space maintainers
Extensive Dental
Benefit Payment – 50-80%
Restorative services:
Restorations
Oral surgery:
General surgery exam
General anesthesia
Endodontics:
Endodontic exam
Root canal therapy
Apicoectomy
Retrofill
Pulpectomy
Pulpotomy
Periodontics:
Surgical:
Periodontic surgery osseous surgery
Osseous grafts
Soft tissue grafts
Non-surgical:
Provisional splinting
Scaling and root planing
Management of oral infections
Prosthodontic appliances (limited to one of the following services per tooth):
Crowns
Fixed bridges
Inlays and onlays
Processed veneers
Posts & cores
Partial dentures
Removable appliances:
Complete dentures
Denture services:
Rebasing and resetting
Adjustments
Relines
Liners
Tissue conditioning
Repairs
Provision for implants
Orthodontic Dental
Benefit payment: 50%
Maximum: $2,000 – $4000 lifetime amount per participant
Diagnostic services:
General orthodontic exam
Cephalograms
Facial/intraoral photographs diagnostic models
Consultation and case presentation
Habit-breaking appliances
Interceptive, interventive, preventive:
Fixed and removable appliances functional appliance therapy formal banding treatment
Pre-authorization:
Usually required for a treatment plan
Life Benefits
| Benefit formula: | Percentage of annual earnings or fixed amount |
| Maximum benefit: | Variable |
| Non-evidence limit: | Variable |
| Termination: | Ceases at the earlier of retirement, termination or age 65 (may be extended) |
Benefit description:
Coverage is usually provided to the employee and/or spouse in units of $10,000 to a maximum of $250,000 per insured. The combined group life benefit plus the optional group life benefit cannot usually exceed $450,000.
Non-evidence limit:
Evidence of insurability is required for all amounts of insurance.
Termination:
Ceases at the earlier of retirement, termination or age 65
Family coverage for the optional benefits is available as follows:
The spouse is insured for 40% of the amount purchased by the employee, and each dependent child is insured for 5% of the amount purchased by the employee. The spouse is insured for 50% of the amount purchased by the employee if there are no dependent children. Each dependent child is insured for 10% of the amount purchased by the employee if there is no spouse.
This benefit covers death and permanent specific injury due to an accident and is offered by many employee benefit plans to provide coverage in addition to life insurance. In the case of a death, the death benefit is payable to the beneficiary, usually as a lump sum. With a permanent specific injury, the benefit amount is payable directly to the employee.
Benefit description:
Each employee covered by group life insurance, accidental death and dismemberment insurance and optional group life insurance may purchase additional accidental death and dismemberment insurance in units of $10,000 to a maximum of $250,000 per insured. The combined accidental death and dismemberment benefit and optional accidental death and dismemberment benefit cannot usually exceed $450,000.
Non-evidence limit:
Evidence of insurability is required for all amounts of insurance.
Termination:
Ceases at the earlier of retirement, termination or age 65
Family coverage for the optional benefits is available as follows:
The spouse is insured for 40% of the amount purchased by the employee, and each dependent child is insured for 5% of the amount purchased by the employee. The spouse is insured for 50% of the amount purchased by the employee if there are no dependent children. Each dependent child is insured for 10% of the amount purchased by the employee if there is no spouse.
Basic Life Insurance
| Benefit formula: | Percentage of annual earnings or fixed amount |
| Maximum benefit: | Variable |
| Non-evidence limit: | Variable |
| Termination: | Ceases at the earlier of retirement, termination or age 65 (may be extended) |
Optional Life Insurance
Benefit description:
Coverage is usually provided to the employee and/or spouse in units of $10,000 to a maximum of $250,000 per insured. The combined group life benefit plus the optional group life benefit cannot usually exceed $450,000.
Non-evidence limit:
Evidence of insurability is required for all amounts of insurance.
Termination:
Ceases at the earlier of retirement, termination or age 65
Family coverage for the optional benefits is available as follows:
The spouse is insured for 40% of the amount purchased by the employee, and each dependent child is insured for 5% of the amount purchased by the employee. The spouse is insured for 50% of the amount purchased by the employee if there are no dependent children. Each dependent child is insured for 10% of the amount purchased by the employee if there is no spouse.
Accidental Death and Dismemberment
This benefit covers death and permanent specific injury due to an accident and is offered by many employee benefit plans to provide coverage in addition to life insurance. In the case of a death, the death benefit is payable to the beneficiary, usually as a lump sum. With a permanent specific injury, the benefit amount is payable directly to the employee.
Optional Accidental Death and Dismemberment
Benefit description:
Each employee covered by group life insurance, accidental death and dismemberment insurance and optional group life insurance may purchase additional accidental death and dismemberment insurance in units of $10,000 to a maximum of $250,000 per insured. The combined accidental death and dismemberment benefit and optional accidental death and dismemberment benefit cannot usually exceed $450,000.
Non-evidence limit:
Evidence of insurability is required for all amounts of insurance.
Termination:
Ceases at the earlier of retirement, termination or age 65
Family coverage for the optional benefits is available as follows:
The spouse is insured for 40% of the amount purchased by the employee, and each dependent child is insured for 5% of the amount purchased by the employee. The spouse is insured for 50% of the amount purchased by the employee if there are no dependent children. Each dependent child is insured for 10% of the amount purchased by the employee if there is no spouse.
Disability Benefits
| Benefit Formula: | 66.67% of weekly earnings |
| Maximum Benefit: | $1,200 per week |
| Elimination Period: | 0 days for accident 0 days if hospitalized 7 days for sickness |
| Benefit Period: | 17 Weeks |
| Non-Evidence Limit: | $1,200 |
| Termination: | Coverage for active employees ceases at age 65 benefits under weekly indemnity (short term disability). Insurance provisions are usually non-taxable. |
| Disability: | To be eligible for this benefit, an employee must be under the continuing care of a physician for the period of the disability, which normally commences with their first visit to a doctor. An insured employee will be considered disabled and entitled to weekly indemnity payments if, as a result of sickness or accident they are unable to perform a substantial portion of the duties of their own occupation or regular employment and are not engaged in any occupation or employment for wage or profit. |
| Benefit Formula: | 60% – 66.67% of the first $2,500 and 50% of the excess of monthly earnings |
| Maximum Issue Limit: | $5,000 per month |
| Elimination Period: | 119 Days |
| Benefit Period: | To Age 65 |
| Non-Evidence Limit: | $1,500 – $5000 (depending on the number of insured employees) |
| Termination: | Benefit ceases at age 65. Coverage for active employees ceases at age 65 less the elimination period. Benefits under this long term disability insurance provision are usually non-taxable |
| Total Disability: | An insured employee is not considered totally disabled during the first 24 months following the elimination period if he is deemed able to do the substantial (60%) portion of the regular duties of his own occupation for any employer. Thereafter, an insured employee is not considered totally disabled for the period following the first 24 months of benefits if he is deemed able to perform at least 60% of the regular duties of any occupation for any employer for which he is reasonably fitted, or could so become, by education, training or experience. |
Short Term Disability
| Benefit Formula: | 66.67% of weekly earnings |
| Maximum Benefit: | $1,200 per week |
| Elimination Period: | 0 days for accident 0 days if hospitalized 7 days for sickness |
| Benefit Period: | 17 Weeks |
| Non-Evidence Limit: | $1,200 |
| Termination: | Coverage for active employees ceases at age 65 benefits under weekly indemnity (short term disability). Insurance provisions are usually non-taxable. |
| Disability: | To be eligible for this benefit, an employee must be under the continuing care of a physician for the period of the disability, which normally commences with their first visit to a doctor. An insured employee will be considered disabled and entitled to weekly indemnity payments if, as a result of sickness or accident they are unable to perform a substantial portion of the duties of their own occupation or regular employment and are not engaged in any occupation or employment for wage or profit. |
Long Term Disability
| Benefit Formula: | 60% – 66.67% of the first $2,500 and 50% of the excess of monthly earnings |
| Maximum Issue Limit: | $5,000 per month |
| Elimination Period: | 119 Days |
| Benefit Period: | To Age 65 |
| Non-Evidence Limit: | $1,500 – $5000 (depending on the number of insured employees) |
| Termination: | Benefit ceases at age 65. Coverage for active employees ceases at age 65 less the elimination period. Benefits under this long term disability insurance provision are usually non-taxable |
| Total Disability: | An insured employee is not considered totally disabled during the first 24 months following the elimination period if he is deemed able to do the substantial (60%) portion of the regular duties of his own occupation for any employer. Thereafter, an insured employee is not considered totally disabled for the period following the first 24 months of benefits if he is deemed able to perform at least 60% of the regular duties of any occupation for any employer for which he is reasonably fitted, or could so become, by education, training or experience. |
HSA - Health Spending Account
Would your younger employees be interested in getting the exact same benefits with no flexibility as, for example, employees that are near retirement?
While a base employee benefits package can share the same features across all employees, a Health Spending Account (HSA) provides employees with the flexibility to customize their benefits experience to their own needs. An HSA is a sum of money that is allotted to an employee for reimbursement of a wide range of health-related expenses over and above regular benefit plans.
HSA employee allowances are also advantageous in that they are not taxable.
EAP – Employee Assistance Program
An EAP is a confidential service that provides employees, and often family members of employees, confidential counseling services about personal well-being issues. These issues may or may not be directly work-related and while the issues may be resolved with short term counseling, referrals can be arranged if longer term therapy is required.
