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Plan & Predict
How rising paramedical claims, drug reforms, and other trends will affect your workplace benefits

Predicting the future can sometimes be an inexact exercise. (I know I'm still waiting for my personal transporter.) But there is no question that several emerging trends will affect workplace benefits in 2015.

Consider the following examples:

1. Rising paramedical claims

Chiropractors, massage therapists and other paramedical service providers continue to account for some of the fastest-growing benefit costs in the workplace. They represented 19.3% of healthcare claims in 2013, up from 15.5% in 2009, according to Great-West Life.

Some of the increases are caused by inflationary pressures alone, but others can be traced to a rising interest in this category of care. Dig a little deeper into Great-West Life's statistics and you will see that the number of people submitting paramedical claims is up 5-25%, depending on factors such as age. The number of utilized services is increasing by 5-10% a year. Some of the largest increases of all are falling into the "other" category of care including acupuncture and naturopathic treatments.

There is no need to panic. This care is often preventive in nature, can help to reduce absenteeism, and will improve an employee's focus on the job. Rising awareness also enhances the role of related benefits in recruitment and retention efforts.

But the costs still need to be managed. Entrepreneurial paramedical providers sometimes promote the idea of using every available dollar rather than simply scheduling appointments based on need alone. Employers can help protect their plans against this threat by establishing maximum payments per visit or practitioner.

2. Prescription pricing reforms

Prescriptions account for some of the biggest healthcare costs. The good news is that pricing reforms are helping to control the related increases.

The Canadian Generic Pharmaceutical Association recently announced that Canadians will save about $3.8 billion through a three-year agreement with the generic pharmaceutical industry. Under that deal, 18 top-selling generic medications will have prices slashed to 18% of the cost of equivalent brand name drugs.

As of January 2014, the average price of a generic medication was $20. The average brand name medication cost $76.

Still, employees must be encouraged to request these medications. Generic drugs are used to fill 86% of U.S. prescriptions, but fill a mere 67% of prescriptions on this side of the border.

Keep in mind that these reforms – and the wider use of generic drugs -- will become even more important as we look to offset the rising costs of new therapies such as emerging biologic drugs, which on their own account for 15% of drug claims.

3. An increasing focus on mental health

Mental health disorders are playing an increasing role in Long Term Disability (LTD) costs – particularly among white collar and management workers.

Several factors play a role here. Stress and work volumes are on the rise. The LTD claims also increase when the economy recovers and employees are less likely to worry about losing their jobs. On top of this, the white collar and management workers tend to have higher salaries, leading to higher claims.

Luckily, the general awareness around good mental health is growing, thanks to programs like Bell's Let's Talk initiative.

Every step toward earlier treatment will help to keep employees at work.

4. The rising costs of a healthy smile

Dentists play a larger role in overall health than many people think. While many patients focus on a healthy smile, there are broader implications. Gum disease can lead to respiratory problems or diabetes, among other challenges.

Routine cleaning, polishing and scaling makes a difference – and was the top dental procedure of 2013.

Still, there needs to be limits. This time of year, many entrepreneurial-focused dentists take the time to ask patients about the available space in benefits plans rather than focusing on needs alone.

It's why employees need to ask dentists about required care, rather than basing choices on the space in an account.

5. Tighter restrictions on orthotics

Plan providers have introduced tighter controls on orthotics for a good reason. These services have been prone to widespread fraud, leaving some people to file a claim whenever they wanted a new pair of shoes.

The threats have been largely offset by introducing requirements for gait tests, recommendations from medical doctors, and custom-made shoes.

The extra steps take time, but will ensure that plan holders who truly need help will receive the required support.

Top Tips:

  • Monitor fixed deductibles. Increasing prices can leave employees to pay a larger share of fees.
  • Ask paramedical service providers and dentists to recommend treatments based on need rather than the annual caps in a plan.
  • Help sustain drug plans by requesting generic forms of prescription medications.
  • Control the costs of paramedical services by establishing maximum payments per visit or practitioner.

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The Buzz Bits
Miscellaneous links to interesting benefits information

Top 3 issues facing group life and health clients today: Insights

How to adapt in a lagging market: smallbizadvisor

Temporary work and no benefits The growing workplace chasm: Globe and Mail

Employees value their benefits: Benefits Canada

Community Ethics, Big City Expertise

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