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Employee Benefit Plans and COVID-19

All we can do these days is speculate. Are we over the worst of COVID-19 in Canada? Is it easing off or are we waiting for another wave? What we can be sure of is that things won’t be the same as they were. Employee benefit plans have changed and will change again as we become more certain of the longer term ramifications of the pandemic.

Out-of-Country Travel

As travel restrictions begin to lift, the policies related to Emergency-Out-of-Country Travel have not changed much.

If you are travelling to a country, even as a vacation destination, that has reopened, you will be covered for eligible expenses, including those related to COVID-19. Conversely, if you are travelling to a country for which the Government of Canada has issued a Level 4 travel advisory (“Avoid all travel”), you will not be covered.  Please call your travel coverage provider (number is on your card) to confirm coverage in the grey areas in between as you may be covered for everything but COVID-19.

Heath and Dental Claims

For the months of April through June, access to dental and many health professionals was very limited. As a result, carriers reduced their premiums during that period. Through the latter part of June and into July, we are seeing a steady increase in claims as dental offices and health care providers began seeing patients again. Though volumes aren’t yet at 100% of what they were earlier this year, we do expect claims to fully rebound soon.

Personal Protection Equipment (PPE)

As dental offices and health practitioners re-open, COVID-19 has caused new safety procedures to come into practice. Dental and heath care staff are now covered in PPE to keep them and their patients safe. PPE is disposable and can be a significant cost. Practitioners are now passing these costs on to their patient as separate line items.  Insurers, however, have determined that PPE costs are not eligible for reimbursement. The exceptions are Health Care Spending Accounts (HCSA), and cost plus as long as the PPE is used for a dental procedure or paramedical practice.

Currently, carriers will exclude PPE on dental invoices paying according to plan design and procedure codes. When health claims are submitted with PPE fees clearly broken out on the receipt or invoice, usual and customary costs will be reimbursed without the PPE costs. Where the PPE has been combined with the service cost and not broken out, the claim will be paid according to your carrier’s Usual and Customary fee guide or it may be denied and claimants may be required to go back to the practitioner for a clarification of the invoice.

However, some employers may, in fact, wish to enhance their plans to include coverage for PPE costs – and, depending on your current funding arrangement, there may be options to do so.

Premium and Renewal Deferrals

Carriers are no longer deferring monthly premiums or renewal dates. Going forward, it will be business as usual for monthly premium payments and effective dates of renewal. Please contact ASSOCIUM in case of hardship.

Health Care Spending Account (HCSA) Credits

The shutdown of dental offices and reduced health care services have limited the opportunities to use HCSA carry forward credits from 2019, where applicable. The Canada Revenue Agency has allowed employers the option of extending 2019 credits beyond the end of 2020.  If you have a HCSA with a carryover option, please contact ASSOCIUM to determine your options. 

Returning to Work

As we return to work or just return to our places of work, it is clear that work life isn’t going to be as it was. The emergency period will continue to be in place and insurance companies and plan carriers are all working to accommodate this new reality. Though they are all working as quickly as possible, the environment is one of uncertainty. As such, ASSOCIUM will be available to support employers and their employees through the times ahead.


ASSOCIUM Benefits is a very unique employee group benefits provider, focused on supporting benefits advisors and their employer clients. We provide Brokers and Plan Sponsors with a range of solutions from traditional group benefits to more customized, cost and tax effective employee compensation. Let’s connect to find out how we can help.

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