GROUP PLANS
Flexible Plans
Some group insurance plans – usually referred to as flexible or cafeteria-style
plans – give members options that allow them to tailor their coverage to meet their
personal circumstances and needs, within certain limits. Each member can choose
to add to a basic benefits package at his/her own expense or, in some cases, with
money from an individual health care spending account provided by the employer.
The advantage of flexible plans is that they let you change your benefits as your
situation changes. You can add orthodontic coverage to your basic dental benefits
when your children are pre-teens, for instance, and drop it later when you no longer
need it. Typically, you can change your coverage once a year and/or upon a major
life event such as a marriage, birth or death. Make sure that you know what choices
are available under your plan; review your plan booklet and discuss it with your
benefits administrator.
Coordination of Benefits
If you and your spouse or partner are both group plan members, coordination of
benefits permits coverage of up to 100 per cent of your eligible expenses. Industry
wide procedures determine which plan considers a claim first, after which the other
plan considers any amount that has not been reimbursed by the first one. Ask
your benefits administrator for details.
If you and your spouse or partner both pay group plan premiums, you may be
tempted to save by opting out of the plan that provides the less generous benefits.
But coordinating the benefits provided by the two plans could be very useful if
someone in your family needs an expensive pair of glasses or orthodontic appliance.
Administrative Services Only Plans
Most group plans are purchased from an insurance company by the plan sponsor.
But some employers pay the costs of group plan benefits themselves, using an
insurance company to administer the plan only. These plans are called Administrative Services Only (ASO) plans. Because these plans are not insured, the insurance
company does not guarantee benefits.
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