Guidelines, Policies, Procedures for Employee Group Benefits

The Benefit Administrator’s Checklist is just the beginning…

Who manages your guidelines, policies, and procedures regarding your organization’s employee group benefit plan? Do you even have a policy that addresses employee benefits?

Silos are common for companies. Compliance officers strategize risk areas like privacy, regulators, and financial duties. Human Resource professionals ensure the human capital and talent support the corporate mandate through inclusion, culture, engagement., amongst a multitude of other duties These are loose, broad strokes of description, but as someone who practices exclusively in the Group Benefit arena, I wonder if there may be a bit of a miss, perhaps an over simplification of expectation when it comes to the “duties” of policies and procedures around benefits, especially if this an outsourced portion of the business and not a dedicated in-house department.

Are you protected from liability when it comes to the benefit plan? 

Do you perhaps ASSUME the benefit plan is already covered by the company’s existing policies and procedures? Perhaps the benefit booklet? Keep in mind, many initial policies and procedures guidelines focus on Employment Standards, Human Rights, Occupational Health and Safety, provincial / federal regulations, privacy and compliance.

So, what is the legal liability attached to employers when there is no existing protocol for:

  • Enrolment mandate—mandatory or voluntary
  • What happens when an employee refuses coverage? 
  • Cost sharing arrangement 
  • Payroll Deductions
  • Common law relationship length of time
  • Waiving off of benefits. What benefits can be waived?
  • Is there spousal coverage in place? How to confirm?
  • Life changes to be reported
  • Travel coverage – exclusion when travelling for example – 90 days stability clause prior to departure, is pandemic coverage available, premature babies 
  • Benefit continuation provisions. If there is a disability claim, how long does the employer continue extended health care and dental, or a health spending account? 
  • Salary adjustments so benefit coverage amounts match salary
  • What happens in a leave of absence (not medical or maternity)?
  • Benefits during maternity leave, lay-offs, temporary, otherwise.
  • What happens if an employee transitions into a long term disability, how long will the employer continue the extended health and dental benefits, perhaps a health spending account, and employment for the employee.
  • Reporting and processing in-active or disabled employees correctly, ensuring correct paperwork completion
  • Employee contribution, is the employee required to provide post-date cheques for their portion of the premium?
  • Actively at work clause in the event of life or disability claims
  • Contact information and access to insurer | benefit provider
  • Tax status, who pays for what on the benefit plan?
  • Last day at employment. What are the conversion options the employee entitled too, employee life, AD&D, CI, LTD (dependent on the specific provider) personal health and dental plans that have 31 days to convert. That the employee has 30-60 days to submit any outstanding health and dental expenses for the past 12 months. How does the employer have to notify the employee—in writing—in person—what needs to be signed?
  • Company reserves the right to alter employee benefits at anytime
    Anti-selection, when an employer doesn’t offer coverage—what is full-time, active, verses part-time, or contract (think of the Uber case here)

This list can of course go on, but I think you get the point.

I am not disparaging Human Resources, or Compliance practitioners or the on-line out-sourced options available, but I am concerned by the number of Canadian Liability cases addressing forms of these very issues. We offer our clients access to the “Administrator’s” Checklist to ensure we are talking about these very concerns and introducing them to professionals, like Murray Whitby, from POLICY PROTEC who can ensure a connection between all silos and keep these up-to-date on a continuous basis. There’s more to benefits than simply paying claims.

Disclaimer: Please note that the information provided, while authoritative, is not guaranteed for accuracy and legality. The site is read by a world-wide audience and employment, taxation, legal vary accordingly. Please seek legal, accounting and human resources counsel from qualified professionals to make certain your legal/accounting/compliance interpretation and decisions are correct for your location. This information is for guidance, ideas, and assistance.