What to consider when workplace benefits are disappearing

What to consider when workplace benefits are disappearing

Workplace health and dental benefits don’t get as much love as they should.

To borrow a line from a 1980s hair band lyric – you don’t know what you’ve got, till it’s gone. 

Or nearly gone.

Such is the case from a reader lately (I’ve changed the names) about their health and dental benefits.  See their questions and concerns summarized below.

Hi Mark,

My husband (Bob) and I are retiring from full-time work within the next six (6) months at age 55.  We can’t wait!!

However, when we retire from work, our workplace benefits (drug, dental and other healthcare coverage benefits such as long-term disability) as part of our group healthcare benefits will cease to exist.  This is a scary thought.  We’re considering various options now including health insurance using medical underwriting plans or going with a group conversion plan but we really don’t understand what all this means in terms of coverage or benefits.  Can you help?

Thanks so much for your site and blog.

Tisha

Thanks Tisha.

No doubt thousands of Canadians when they retire are in the same boat. 

Health and Dental Benefits

I have full confidence some passionate readers might also be able to provide some guidance based on what they have done.

Since I’m versed although not a pro in this area, I decided to reach out to someone who is.  Enter Brian So, a fan of this site, a life insurance agent who runs his own site, and helps Canadians with these insurance needs and more every day.

  1. Brian – what options should Bob and Tisha consider now that they are stranded without any healthcare plan?

That’s a great question Mark. It can be scary relying on group benefits your entire working life and then suddenly losing them. Fortunately, they have several options.

If they are still in relatively good health, they can purchase a medically underwritten plan. This will give them the most choice in terms of the level of coverage they want. They would have to complete a medical questionnaire and any existing medical conditions will be reviewed by the insurance company to verify if they will be covered. And because the plan is medically underwritten, it will have the lowest premium out of all their options.

If their health has deteriorated, they can opt for a group conversion plan. This lets them get coverage without completing a medical questionnaire or exam. But they must apply within 60 days of the end of employment to qualify.

If they pass the 60-day deadline (associated with the group conversion plan), and they have chronic health issues making them ineligible for the medically underwritten plan, they would have to settle for a guaranteed acceptance plan. This is the least preferred choice with the most limited coverage and higher premiums.  (They should try and avoid this type of plan if they can in my opinion.)

  1. Brian – is there an option to ‘opt-in’ to any healthcare coverage without any medical exam?  Say, within 30 or 60 days of workplace benefits coverage eliminated? What are the pros and cons of this?  Also, should our readers be concerned with the underwriting process in that they were covered under many healthcare benefits from their group plan but now, might not be?

Mark, (and for Bob and Tisha), this would fall under the group conversion plan described above.

The advantage of this plan is it gives them guaranteed coverage without a medical questionnaire or exam – same as when you joined your place of employment.

Treatment related to existing medical conditions is covered since they don’t have to answer any medical questions. Plus, they can also start using the plan immediately, instead of having to satisfy a waiting period like with the medically underwritten plan.

The downside of the group conversion plan is you have to apply quickly since there’s a deadline of 60 days after employment ends. The premium is also higher than the medically underwritten plan.

  1. Brian – I’ve assumed Bob and Tisha want to travel a bit or enjoy new experiences in their 50s and 60s during their “GO-GO” retirement years as some people call this phase. Is there specific coverage they should be looking at?

Because provincial health insurance only covers a tiny portion of health care costs while they are outside their province, they should strongly consider travel insurance from a private insurer. This can be an add-on to their existing healthcare plan or it can be a standalone coverage.

For our new 50-something retirees, I would suggest they get an annual multi-trip plan that covers them for an unlimited number of trips out of the country for the year.  Such a plan will cover medical emergencies with a limit of $5,000,000 or $10,000,000.

Insurance companies will have a choice of maximum trip length for multi-trip plans, so they should match it up to their longest expected trip – say 15-days or 21-days, and so on.  If their longest trip exceeds the maximum trip length of their plan, they can always buy a single trip policy to extend their coverage.

For example, if they choose a 15-day multi-trip annual plan and they take a 3-week vacation, they can top-up their coverage with a 6-day single trip policy.

  1. Brian – let’s talk money. What might the typical cost for a healthcare plan be? Let’s assume both Bob and Tisha are non-smokers, in good health.  Should they be concerned their premiums might rise over time?

I ran some quick numbers for them.

For a 55-year-old couple:

  • A medically underwritten plan will cost $264/month.
  • A group conversion plan will cost $410/month.

(Both of these quotes are from Pacific Blue Cross, just for an example.  (No affiliation by My Own Advisor.)  There are many other carriers.)

The healthcare plans cover:

  • 80% of the cost of prescription drugs up to a maximum of $5,000 per person per year.
  • 80% of basic dental services up to a maximum of $1,200 per person per year with 2 recall visits per year.
  • 50% of major restorative services.
  • 50% of orthodontics.
  • $300 per person every 2 years for vision care.
  • $500 per person per year for registered therapists and health practitioners (physiotherapists, chiropractors, etc.).
  • $5,000 per person per year for medical services and supplies not covered by government plans.
  • Miscellaneous benefits such as private duty nursing care, accidental death & dismemberment, etc.

Some of these limits begin at a lower amount in the first year and gradually increases to reach the maximum after 4 years.

For the second part of the question, while the premium isn’t guaranteed and can increase every year, they shouldn’t worry about a substantial increase in premium. It usually goes up only a few dollars per year and everybody in their age group is affected so they don’t have to worry about being singled out for using their plan excessively.

  1. Brian – I always like to provide readers with insight on where they can learn more – for free. Any websites (no affiliation) that offer great comparison quotes for personal healthcare plans for retirees?  Any particular companies that you feel, personally, offer a good bang-for-buck? Again, no affiliation?

All good Mark, re: no affiliation.

I like to use Kanetix.ca for my research since it searches several insurance companies and has a user-friendly interface. The list isn’t comprehensive though, so I always check the individual insurance company’s website (and use my own software) for a more thorough list.

As for the second part of your question, I believe Pacific Blue Cross offers the best bang for your healthcare buck (again, no affiliation – just an example). It gives you the choice of either basic or enhanced coverage for dental and prescription drugs and it offers the most competitive premium amongst all providers. Plus, it’s a not-for-profit organization so all the profits are reinvested back into the business for the benefit of its members.

  1. Brian – should prospective retirees consider working with an insurance broker (at no cost to them) to find the best personal healthcare plan?  Why or why not?

Great question Mark.

Really, there are 2 types of people: those who like to do the research themselves to make sure they have the right plan, and those who would rather save some time and work with an insurance broker to find them the right coverage.

The right answer to your question depends on what type of person you are.

I suspect many readers of your blog are the DIY-type or they want to be the DIY-type so they would enjoy doing the research. But even if they are, they should still check with an insurance broker to see if they are getting the best plan. And whether they go through an insurance broker or buy it themselves, it still costs the same, so it doesn’t hurt to have a second opinion. Besides, an insurance broker can provide ongoing service related to the healthcare plan or other insurance products.

Great stuff Brian and I think this post will help many retirees in this situation.

If you have questions for Brian, he’ll be happy to answer them below on this site and keep the conversation going.  Alternatively, if you have a specific set of questions for him – don’t hesitate to reach out.

Brian So is a life insurance agent based in beautiful Vancouver, British Columbia. He runs Brian So Insurance (no affiliation) and is committed to helping his clients find the best coverage for their needs. He takes a holistic approach to insurance, implementing life, disability, critical illness, healthcare and long-term care insurance into his clients’ risk management plan to provide comprehensive coverage for their families.

How are you navigating your loss of workplace benefits?  What is that costing you?  Did you factor that into your retirement budget and plans?  Let me know and share in a comment below. 

My name is Mark Seed and I'm the founder, editor and owner of My Own Advisor. As my own DIY financial advisor, we're inching closer to our ultimate goal - owning a 7-figure investment portfolio for semi-retirement. We're almost there! Subscribe and join the journey. Learn how I'm getting there and how you can get there too!

28 Responses to "What to consider when workplace benefits are disappearing"

  1. Thanks, Mark for the guest posting opportunity! I had a blast with this one and hope your readers near retirement can take away something new from it.

    Hey readers, just post any questions you have here and I’ll do my best to get back to each of you.

    Reply
  2. Thanks for this post Mark. And Brian for your advice. I will be in this situation within the next 2 years. To confirm, a medically underwitten policy is one where we would answer the medical questions in the hopes that the premiums would be less than a conversion plan? I am 56 and take both a high blood pressure and a cholesterol pill daily. My wife is prescription free (so far!). Besides a couple of trips to the dentist annually we dont have any other medical needs. Do you know what 2 rx’s might do to those premiums?
    If say, we are in the $400 per month range for premiums, we might be wise to do the math and potentially go without insurance at all?
    Thanks again
    Chuck

    Reply
    1. Hey Chuck, the insurance company may offer a plan with a higher premium to account for the increased risk. Of course, you’ll have to submit an application to know the exact amount. Different insurance companies have different underwriting standards, so while one may offer a higher premium, another may consider the risk acceptable and give you the standard premium.

      For the last part of your question, it depends on your situation. It probably makes more sense when you consider the cost to go without insurance, but that is only looking at the present. If your health worsens down the line and you will need to use the benefits more, then the $400/month will seem like a bargain. Because by then you won’t be able to qualify for a medically underwritten plan.

      Reply
    2. Correct: a medically underwitten policy is one where we would answer the medical questions in the hopes that the premiums would be less than a conversion plan. With a sort of “no medical” group coverage, the underwriting process is after the fact, when claims are made and could be subject to more scrutiny.
      You avoid that by having the underwriting process approved free and clear up front – just life insurance in that respect.

      I’ll let Brian respond to other details. Thanks for being a fan.

      Reply
  3. Hi Brian/Mark,

    I have 2 questions:

    1) The premiums ($264 or $410/month) you provided are quite expensive to us. Can you give us estimates without dental coverage?
    2) Would the price range be similar if coverage started at 60 instead of 55?

    Thanks in advance for your insight!

    JD

    Reply
    1. Hi JD,

      1) The premium will be $124/month without dental coverage. Or you can even choose the dental option without major restorative services and orthodontics for $195/month.
      2) The age bracket with this insurance company is 55-64, so it currently costs the same. Different companies have different brackets, and rates are subject to change all the time too, so it will look different if you wait until age 60.

      Reply
  4. I recently looked into optional health coverage because my contract job, that included benefits, ended. I found the monthly premiums in the ballpark of what’s quoted above, and Pacific Blue Cross was one I looked into, and not really great coverage. See above for dental – $1200/year and the patient still pays 20% of the cost up front. I don’t have prescription meds and no other health or dental concerns. I didn’t see the value of spending $150/month premium when over the course of a year chances are slim that I’d use any of the services. I’m thinking a savings account where I can set aside $100 or $150/month in a HISA for health care needs might make more sense.

    Now I might change my tune if I need expensive drugs down the road!

    Reply
    1. Hey Cheryl, that’s the thing with insurance though. If you do need expensive drugs down the road, it means you have some medical conditions and would either be:

      1) Offered a policy with an exclusion for that medical condition,
      2) Offered a policy with an increased premium, or
      3) Declined coverage.

      None of which are ideal options.

      Insurance is mainly for healthy individuals who want to lock in their rates so they can make use of the plan down the road if/when their health deteriorates. Some will be healthy their whole lives and ‘lose’, but others won’t be as fortunate with their health but ‘win’ against the insurance company. But either way, by buying insurance you’re transferring the risk to the insurance company so you don’t have to bear the entire risk. This risk management perspective is just another way of looking at it.

      Reply
      1. Thanks Brian. That’s the way I’ve always viewed insurance. You are transferring the risk (of a major financial loss or setback to another party that you cannot self-insure for) to the insurance company in exchange for premiums. It’s not ideal but it’s all we can do unless we want and can, self-insure.

        Reply
    2. Thanks Cheryl for sharing. Certainly not an easy decision for any self-employed or early retiree. I think when searching, definitely search different sites for different age range packages. Not all insurance is created equal for sure and an insurance broker can help you do the heavy lifting.

      Mark

      Reply
  5. Thank you – this was timely info for me. I carried on with my employee plan as a retiree. Adequate (but not great) medical and dental coverage for a much lower premium than those in the article. Because the cost for single coverage has been going up from 5% to 10% a year since I retired, I was thinking of looking elsewhere. Now I won’t, as it would seem I am lucky.

    Reply
  6. Lots of good info Brian, thanks. You never know how your health needs will change over time. I just dont want to blindly convert my employer plan without some investigation. I will reach out to you a few months before retirement.
    Thanks for the post Mark

    Reply
  7. I will miss the travel coverage. We have always had unlimited travel coverage, no restrictions and good for trips up to one year in length. Never had to use it, but nice to know it is there. I am away on a 2.5 month trip now.
    And I guess it would suck to be stuck in a ward room if you had to be hospitalised. But the other things? Just have to budget for them, we have good health care in Canada.

    Reply
  8. Just went through this myself. So many options. Ended up purchasing with ARTA (Alberta Retired Teachers Association) and pay under $300 per month for top dental and basic health coverage. Did not take the travel insurance as we don’t plan to travel that much and it will be cheaper to purchase travel insurance as required. It has different coverage levels and other professional groups (nurses, fireman, etc…) can also join. Check the website for more information.
    We needed specific coverage for a CPAP machine and this was the best of the ones I investigated. Also, I believe premiums are tax deductible which helps.

    Reply
    1. Hey Gruff, thanks for sharing. That’s a good price for top coverage.

      Actually, the premiums are not tax deductible. However, they are eligible for the medical expense tax credit. This means expenses in excess of the lesser of $2,302 for 2018 (indexed annually by inflation) or 3% of net income can be claimed for the federal tax credit.

      Reply
  9. Good information. This is stuff that might get lost in the weeds with some folks when planning for retirement, after taking for granted some workplace benefits that might be lost.

    As retirees we have a plan through my wifes former employer. We spend approx $125/yr or $1500 per year now for what you see below.

    Medical family plan 100% paid by employer to age 65. The pharmacy drug portion reverts to Provincial plan at 65. Cost approx 424 annually each, plus 30% of prescription with a ~$ 400 cap vs. $5.00 co-pay currently. Expect to pay ~1500 yr. in about 5 yrs.
    Dental family plan approx $95 monthly
    Life insurance, AD&D small amount $9 monthly. Will keep until CPP/OAS starts.
    Travel insurance -unlimited # trips annually up to 35 day length $8.20 monthly. Extending to include 1 60 day trip adds ~$9.00/mth
    Travel trip interuption insur. $6.83 monthly. Extending to 1 60 day trip adds ~$1.00 mth
    The travel rates depend on age. As we age they get more expensive.

    Reply
      1. You’re welcome. I should correct the monthly part of the spend line to read:

        We spend approx $125/mth or $1500 per year now for what you see below.

        Reply
  10. I know my dad is over 65 and at 65 the drug coverage limit dollar amount was reduced substantially. Thats why i’m not sure i want insurance when i retire. Is this common?

    Reply
    1. Hi Christina, I don’t believe that is common, at least not with the insurance companies I deal with. You’ll want to read the contract carefully just to be sure though.

      Was it part of an employer benefits plan or a personal healthcare plan?

      Reply
  11. What I really want is a true insurance policy that only kicks in when the costs are very high, and has no maximum.
    I can finance my own dental checkups and glasses, and even the first couple of thousand dollars worth of surpises.
    Is there anything like that out there?

    Reply
    1. Not with a healthcare plan. The closest product that would cover what you’re describing would be critical illness insurance. You can buy a lump sum amount of $10,000 to $2,000,000 that you can use to cover your additional expenses (drugs, treatment, etc) in the event you suffer from a covered illness. There are typically 25 covered illnesses but some only cover the big 4 (cancer, heart attack, stroke, coronary artery bypass surgery).

      Reply

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