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Two cases with very different outcomes have changed how I look at benefits 

By: Bill Zolis

Yes, I, along with my colleagues and most of the people who read this blog are in the benefits management business, and we deal with issues professionally every day. But it was two very different real-world situations within the orbit of my personal acquaintances – people who have touched my own life – that really made me think about one oftenoverlooked aspect of benefits. 

I found myself asking two fundamental questions: Why do we have benefits? And are we doing enough to educate our clients about what’s most important? 

Let me explain. 

I’ll start with the case of a man I’ll call Robert. I’ve known him for a long time – his circle of family and friends overlaps with mine. He is 33 years old, has a home and a family, and has worked his way up to a pretty good job in the transportation sector. He was making about $70 thousand a year, and had every prospect of moving up in his career. 

Then he was diagnosed with a fairly unusual form of cancer.  

Now, as we all know, there are many, many different forms of cancer, and some of them fall into the category of “rare form” or “unusual.” That unfortunately means that any drugs that are available – and there aren’t that many – are produced in small quantities. Which makes them very expensive. 

Robert is off work – has been for some time. His treatment includes one of those expensive drugs for rare cancers. But we have publicly funded Medicare in this country, right? And he had a benefits plan at work, right? So he should be all right, at least financially, right? 

Well, no. 

First of all, Medicare in Ontario does not cover the cost of his highly specialized drug (although it is covered in BC). It runs to $2500 every two weeks, and it’s not on the list of drugs approved by Ontario’s system. Even the Trillium Fund for rare drugs won’t cover it. (I’m not sure why this particular drug isn’t covered, but, as I discussed in a previous blog about Pharmacare, there are many “orphan drugs” out there, and some of them run into the hundreds of thousands of dollars a year, with no guarantees and often not enough science to prove they will make a significant difference in the outcome.) 

Second, yes, he had a benefits plan at work… but his long-term disability maxed out at $2500 a month (salary was $70 thousand a year), and his drug plan maxed out at $1200 per year.  His wife’s plan which is now gone (contract work) also denied this drug when she had the plan. 

Robert wasn’t our client but I was asked to help.  Those of us in benefits management are all pretty familiar with the various scenarios. 

The fact is, when you’re 33 years old, you look at your benefits plan – if you look at it at all – and you’re more interested in the $200 every two years for eye glasses, or the dental plan for your kidsAt 33, you don’t tend to think about disabilitySo Robert never gave it a second thought.  When the fire happens then you look at your available coverage. 

The second case is one I wrote about in a previous blog, concerning the terrible motorcycle crash suffered by a man named Andrew, an employee of one of our client firms. 

Andrew was riding his motorcycle to the bike shop for an oil change. Ironically and perhaps fortunately, he had just purchased a new bike helmet there a short time before. A car lost control, skidded across the road, struck him and threw him a great distance from the road. 

He was unconscious and badly injured, but EMS paramedics came to the rescue and got him to the hospital in time. He was in a coma for weeks. He lost one leg and the use of his right arm. He was blinded in one eye. He had over 40 bone fractures. 

I first met Andrew in the hospital, when he was starting to recover, and I stopped by to see him and deliver a cheque. But remarkably – and this is what that previous blog was really about – I saw Andrew again months later when he was a guest speaker at a Breakfast Club meeting of the Canadian Group Insurance Brokers.  Andrew is an amazing person. 

His talk was titled “The Good, the Bad and the Great” in reference to how he had been treated by his employer and his benefits plan after his accident. To make a long story short, he felt that his treatment fell into the category of “Great” and he spoke of his gratitude, all the support he had received, and his hopes for the future.  His wife was and is a superstar. 

His plan covered all the essentials – sufficient income replacement through LTD, any drugs not covered by Medicare, his wheelchair, weeks of physiotherapy, his $140,000 prosthetic leg. 

Andrew, who is a writer and is trying to get his life back to as near normal as is possible under the circumstances. It was a terrible ordeal for him and for his family – but it was not the financial catastrophe that it might have been if he had not had the benefits plan that he did. 

Robert’s case, in contrast with Andrew’s, is what got me thinking about the big picture.  

First, why do we have benefits? Sure, we’ve talked about this before – employee attraction and retention, the well workplace, because we care, because it is an expected standard, and so on. All of them important. But really, now. Is it about the vision plan – which is nice, don’t get me wrong – or is it about fundamentally safeguarding our people, their families and their futures? 

Which leads me to the second question: When we talk to our clients, and when we give them the information they need to talk to their plan members, are we doing enough to put that big picture in proper perspective? Are we putting too much emphasis on the bells and whistles, and not enough on the essentials, such as LTD and drug coverage…Critical Illness, Life Insurance?  Is Insurance there to mitigate risk or ….. 

When the catastrophic happens to one employee, everyone in the workplace and community is affected. How well the benefits plan – and, by extension, the employer – handles the situation, becomes part of the culture of that workplace.  

I’ve always talked “big picture” plus have included specifics with our clients, but these two cases, Robert and Andrew, well, they make it personal.  I have always felt that real stories can really put things into perspective. 

*** 

I really appreciate comments, ideas, suggestions or just observations about the blog or any other topics in benefits management. I always look forward to hearing from readers. If there’s anything you want to share, please email me at bill@penmore.com 

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