Frequently Asked Questions

Yes, contrary to popular belief, you can review your benefits program at any time. This won't impact rates immediately or affect members while the quoting process takes place, if that's what you choose.

A formal marketing letter or agent of record must be signed before another broker can engage to obtain quotes on your behalf. However, an initial discussion of what you're trying to achieve should take place before any letters are signed.

For group benefits in Canada, the "right" level depends on your headcount, workforce demographics, budget, and how benefits fit into your provincial health care coverage - company size mainly determines what's available to you and how it's priced. Here's how to think it through:

Check the minimum group size first. Most Canadian insurers require at least 3-5 full-time employees to qualify for a group plan, and typically require at least 70% employee participation to keep the risk pool balanced (this prevents only your sickest employees from signing up).

Understand how size affects structure and pricing:

• Small groups (roughly under 50 employees): Plans are usually "pooled" - priced against industry-wide claims data rather than your own claims history, since you don't have enough employees to generate statistically reliable data. Premiums are more predictable but less negotiable.
• Mid-size groups (roughly 50-200 employees): You start to get partial "experience rating," where your own group's claims history begins to influence pricing, plus more room to negotiate plan design.
• Large groups (200+ employees): Full experience rating applies, and you gain real negotiating leverage - better rates, more customization, and sometimes the option to self-fund (administrative-services-only/ASO) rather than fully insure.

Build coverage around what provincial health care doesn't cover. Group benefits should supplement, not duplicate, your provincial plan (OHIP, MSP, etc.). Core "must-haves" for most Canadian employers are:

• Prescription drugs
• Dental
• Paramedical (physio, massage, psychologist, chiro)
• Basic life and AD&D
• Short- and long-term disability

With more than 3,000 members and trusted third-party administration partners supporting over 30,000 members under administration, we leverage strong purchasing power on behalf of our clients.

That said, benefit plan renewals are influenced by several key factors, including your plan's claims experience, premium-to-claims ratio, credibility, demographic changes, economies of scale, and broader healthcare inflation.

Our role is to help you understand these factors and proactively manage costs through thoughtful plan design, cost-containment strategies, renewal negotiations, and sustainable coverage solutions that support your business over the long term.

Group benefits are a shared responsibility. The employer (plan sponsor), broker, carrier, third-party administrator (where applicable), and employees all play an important role in ensuring a plan runs smoothly.

As the plan sponsor, your organization is responsible for understanding the terms of your plan and managing employee enrolments, terminations, and plan changes through your administrator portal. These responsibilities are reviewed during implementation and onboarding, including key contacts, processes, and administrative training.

We understand that internal roles change over time. That's why we provide ongoing support to help onboard and train new plan administrators, ensuring your team remains confident and your benefits program continues to run efficiently.

Under a traditional broker arrangement, we do not have direct access to your plan administration portal. However, where appropriate, we work alongside trusted third-party administrators who can provide enhanced day-to-day administrative support, assist members directly with complex claims, and help reduce the administrative burden on your internal team. Given the confidential nature of health claims, this also helps protect employee privacy while ensuring members receive the support they need.

Your organization will also have dedicated client service contacts at each insurance carrier for day-to-day administration. We work closely with these teams and are available whenever additional coordination or strategic support is needed, including employee transitions, plan changes, portal demonstrations, carrier escalations, and ongoing administrative guidance.

The employer has the contract with the provider, and is 100% responsible for cost. There are different billing arrangements - however, most carriers are paid through PAD on the first Friday of every month.

From there, the plan sponsor (employer/company) remits the employee share through their chosen payroll method and/or software, whether that's 50%/50%, 75%/25%, or 100% employer-paid. We're here to help you understand how each benefit line is taxed and what's recommended for your industry and company size for the cost share.

Regardless, in order to have a group benefits contract, the employer must pay 50% of the cost of benefits. We can help guide you on how to structure the set-up tax-effectively in your payroll program.

Many insurance providers require a minimum participation level before they will offer or maintain a group benefits plan. In most cases, the expectation is 100% employee participation for all eligible employees, unless an employee can provide proof of comparable coverage through another plan. Employees who have coverage through a spouse's group benefits plan are typically permitted to waive Extended Health and Dental benefits or choose to coordinate benefits between the two plans, subject to the carrier's rules and your plan's eligibility requirements.

Participation requirements vary by insurer and plan design. We help employers understand these requirements, ensure compliance, and structure plans that balance carrier expectations with the needs of their workforce.

These insurance structures depend on the size of the company, benefits history, budgeting, cash flow, and internal capacity to absorb risk. The right funding model depends on your organization's size, claims history, budget, cash flow, and long-term benefits strategy - there's no one-size-fits-all solution. No single structure is inherently better than another; it comes down to where your business's benefits experience, budget threshold, cash flow, and claims patterns fall, and whether the company can self-insure.

Administrative Services Only (ASO)
Your organization pays eligible claims as they occur, while the insurer provides claims adjudication and stop-loss protection for large claims. ASO plans are typically best suited for larger, more stable groups. Hybrid arrangements are also available (e.g., ASO Dental with fully insured Extended Health).

Fully Insured (Traditional Benefits)
Your organization pays a fixed premium, typically for a 12-month period, while the insurer assumes the financial risk of claims. This is the most common funding model for small and mid-sized businesses.

Pooled Plans
Available through select third-party administrators, pooled plans combine multiple employers into a larger risk pool to provide greater renewal stability. While they can offer predictable pricing, they may provide less flexibility and transparency than ASO or fully insured plans.

Regardless of the funding model, certain benefits - such as Life Insurance, AD&D, Critical Illness, and often Short- and Long-Term Disability - are typically pooled due to the nature of the risk (this can be subject to company policy).

The first step is an introductory meeting. Bring your current benefits booklet, renewal documents, and any feedback on your existing program - whether it's related to service, claims, onboarding, carrier support, the employee experience, or simply a lack of proactive guidance.

If you decide to explore the market, an executive team member will sign a Letter of Authorization (Marketing Letter), allowing us to obtain competitive quotes from insurers. This does not appoint us as your broker or commit you to making a change, and multiple brokerages can market your plan at the same time.

When you leave an employer that offered a Defined Contribution Pension Plan (DCPP), Group RRSP, or other workplace savings plan, you'll typically have rollover options within a limited timeframe - often around 60 days. If no action is taken, many providers automatically transfer your savings into a default investment program, which may not align with your long-term financial goals.

This is an important opportunity to review your options. Some individuals choose to consolidate their workplace savings with their personal investments, creating a more cohesive strategy. Others may remain in the group plan to benefit from its low-fee investment options.

We'll help you understand your choices and ensure your investments continue to align with your goals, risk tolerance, and long-term financial plan.

Leaving an employer or approaching retirement is a time-sensitive opportunity to ensure your pension and retirement savings align with your long-term financial goals. Some decisions - such as selecting a pension payout option - may be permanent and cannot be reversed.

Our team can help you understand the advantages and trade-offs of each option, including tax efficiency, investment flexibility, liquidity, annuities, pension transfers, and other retirement income strategies. Working alongside our in-house Certified Financial Planners (CFP), we'll help you make an informed decision that fits your broader financial plan.

Eligible employees should notify their plan administrator within 31 days of becoming eligible or experiencing a qualifying life event (such as marriage or the birth of a child). Enrolling within this window helps ensure coverage is approved without additional medical requirements. If you miss the enrolment deadline, you may be required to complete a health questionnaire and, in some cases, coverage could be declined. These timelines help maintain the fairness, integrity, and long-term sustainability of the group benefits plan.

If you have coverage through another plan, such as a spouse's employer, you may be able to waive certain benefits or coordinate coverage between both plans. We recommend enrolling within the eligibility period first, then reviewing your options once proof of alternate coverage is available. We're happy to help you determine the approach that's right for you.

Leaving an employer is an important time to review your insurance coverage - whether you'll be relying on your own plan, a spouse's benefits, or purchasing individual coverage.

There are strict conversion deadlines that allow you to transition certain group benefits without new medical underwriting. Missing these deadlines may limit your options or require medical evidence.

Typical conversion timelines include:

• Life Insurance, Critical Illness, and Disability Insurance: 31 days (provider-specific)
• Extended Health & Dental: 60–90 days, depending on your current carrier; coverage may be converted to an individual plan with the provider of your choice.

We recommend reviewing your options as soon as you're considering leaving your employer, so you don't miss these time-sensitive opportunities and can make the best decision. Our team can help you compare your options and determine the coverage that best fits your next stage of life.

Employer-sponsored benefits are designed around a variety of factors, including total compensation, workforce demographics, and economies of scale. Most plans are carefully benchmarked and tailored to the organization's size and workforce, making it difficult to directly compare benefits between a startup and a large employer - even within the same industry. Many organizations also offer tiered benefit plans based on role, employee class, or years of service.

If you're considering opting out of your employer's plan, you'll typically need to provide proof of comparable coverage elsewhere and sign a benefits waiver. Keep in mind that re-enrolment may be limited to a future qualifying life event or annual enrolment period.

In most cases, employer-sponsored plans provide greater value than individual health insurance because employers often subsidize a significant portion of the premium. They also offer guaranteed coverage without medical underwriting, provided you enrol within the required eligibility period. We're happy to help you review your options and determine what's best for your situation.

Claim Denials

Claim denials can range from simple to complex to resolve. As a first step, it's worth checking a few basics: review your receipts against what was submitted through the portal, and resubmit if anything is missing or incorrect. If the issue isn't clear, call into customer service - they can help clarify the complexity, including whether a special authorization form is missing. If you're a new member, it's also worth double-checking that your date of birth and name match exactly what's on file in your plan administrator's system.

Switching Insurance Providers

If your employer has recently changed insurance providers, most ongoing prescriptions and coverage are transferred automatically. However, you may need to update your new member ID and plan information with your pharmacy, dentist, or other healthcare providers. In some cases, a new special authorization form may also be required.

Biosimilar Initiatives

Many insurers also participate in provincial biosimilar initiatives. This means certain brand-name biologic medications may only be covered if a biosimilar alternative has been tried or prescribed, unless an approved medical exception applies. These programs are driven by provincial governments and are regularly updated to improve the sustainability of public and private drug plans.

If your claim has been declined, we're happy to help you understand the reason and guide you through the next steps.

Typically, this comes down to one of two reasons:

1. The practitioner is not registered with your insurance carrier. While most healthcare providers register with as many insurers as possible, some choose not to participate with certain carriers.
2. The insurer has chosen not to work with the practitioner. This is less common but can occur when a provider has been removed from a carrier's network due to administrative concerns, unusual claiming patterns, or suspected benefits fraud.

If your practitioner isn't eligible for direct billing, you can often still submit the claim yourself for reimbursement, depending on your plan. If you're unsure why a claim was declined, we're happy to help you review the details and explain your options.

Not all practitioners charge the same fees, and not all services are covered at 100%. Your plan may reimburse a percentage of the cost (e.g., 80%) or up to a maximum amount based on your carrier's fee guide or annual benefit limits. Any remaining balance is your responsibility.

If a practitioner doesn't offer direct billing, it simply means you'll pay for the service upfront and submit the claim to your insurance carrier for reimbursement. Many providers choose not to direct bill, and it does not affect your eligibility for coverage.

Before your appointment, it's always a good idea to confirm whether the practitioner accepts your insurance carrier and, for larger treatments, request a pre-treatment estimate/determination to understand your expected coverage and out-of-pocket costs.

Whether you're purchasing insurance for the first time, have recently lost workplace benefits, are self-employed, or simply want to review your current coverage, we'll help you understand your options. Together, we'll assess your needs, budget, short and long-term goals to recommend a personalized combination of health and dental, life, disability, critical illness, travel, and other insurance solutions that fit your stage of life. Get in touch with our team. 

Bring any current documents or copies of documents and we will review together and create an action plan from there.

Absolutely. Whether it's life, critical illness, disability, or another individual policy, we're happy to review your existing coverage. We'll check your coverage amount, premiums, and any riders or exclusions, and let you know if it still fits your needs, budget, and life stage, with no obligation to make changes.

Yes. There's no limit to how many life insurance policies you can hold, as long as your total coverage is reasonable relative to your income and financial obligations. Many people layer policies, for example combining term and permanent coverage, or personal coverage alongside an employer plan, to fit different needs and budgets over time.