Each year the various provincial dental associations set the suggested dental fee guide for the coming year.  Most dentists follow this guide to charge for the regular work they perform (there are also specialists guides and orthodontics are different again).  Most insurers also use them as a guide for ensuring a fair amount is paid (like a reasonable and customary (R&C) table) for the reimbursement of dental claims.

2023 is looking to be the highest increase I’ve seen in my 26 years in the business.  This is likely in response to the higher costs incurred during the pandemic and the recent jumps in the inflation rate.  So far, we’ve heard from Ontario with an increase of 8.5%, Quebec at 9.8%, Manitoba 5.25%, PEI 5.77%, Saskatchewan 5.62%, and Alberta with 6.0%.

On top of the fee guide adjustment, which increases the cost for the service, we are also seeing increases in trend (coming back more often) and utilization (sitting in the chair for longer).  Together these will mean dental costs will increase by about 10% if you are an AVERAGE user.  Plans facing their first year renewal (with a new plan) will often see much higher increases as employees get work done that had been put off until the plan was put in place.

The ODA Suggested Fee Guide

Ontario dental fees may also be influenced by the ODA’s annual Suggested Fee Guide. The Guide lists every dental service that dentists may perform. It also outlines dental codes and suggested fees for each specific service. Both dentists and dental plan providers may use the Guide as a reference point to help inform service fees.

Dentists are not required to follow the Guide or any fee schedule. They set their own fees based on the factors influencing their individual practice. This means that your dentist’s fees may vary both above and below the Guide. 

Many dental plan carriers will base their plan coverage on fees and codes within the Guide. In some cases, the coverage may be based on previous years’ Guides (going back a year or more). Dental plan providers do not work with the ODA to develop the Guide.

Dental Costs Explained

The Globe and Mail has reported that Ontario is prepared to implement a biologic and biosimilar mandatory switching policy following leaders like British Columbia, New Brunswick, Alberta, Saskatchewan and PEI.  The new strategy is expected to take place on March 31, 2023 and phase in over the year. 

So what does this mean to you and your employees?  Biosimilars are similar (but not the same) as generic drugs and have a reduced cost compared to the Biologic drug they replace.  The costs of the drugs themselves are in the tens of thousands of dollars a year, so the savings can be significant and anywhere from 17 to 50% off the comparator drug.   

Once this program goes into place, those that use the Ontario Drug Benefit plan (ODB), such as; seniors, those on Ontario Works, or the Trillium Drug Benefit will be made to switch to the cheaper biosimilar drug (unless there is a medical reason not to). Most employee benefit plans will mirror that change (Green Shields has been for years already), requiring the employee to change.  This will help control the costs paid by the employer (and often shared with the employee).  Expect to see more on this in the coming year.

“Under the new policy, there will be a nine-month transition period that is set to start March 31. That will allow patients time to have discussions with their care providers about what the changes mean, as well as their options. Certain patients will be exempt from mandatory switching, such as those who are pregnant and people with certain types of cancer, the government official said.”

https://www.theglobeandmail.com/canada/article-ontario-mandatory-drug-swap-generic/

I got this article (below) that acted as a reminder of Ontario employer obligations under the updated OHSA regulations  I’ve include the article and the provincial site providing more detail and locations where you can get your free kit (most pharmacies).

Does your workplace have a naloxone kit? Are you legally required to have one?

In light of the opioid crisis, the Ontario government passed Bill 88, Working for Workers Act, 2022 ( Act ), which amended, among other things, the OHSA to prescribe the inclusion of naloxone kits in select workplaces.

The OHSA now requires an employer who becomes aware, or ought reasonably to be aware, that there may be a risk of a worker having an opioid overdose at the workplace to provide and maintain a naloxone kit in the workplace.

READ ARTICLE

Naloxone can temporarily reverse an opioid overdose. Learn how to recognize an opioid overdose and use naloxone to reverse it.

https://www.ontario.ca/page/get-naloxone-kits-free

We’ve been playing a guessing game since the federal government first announced changes to the EI sickness benefit back in the April 2022 budget.  When it would happen, and how it would work with private sickness benefits (WI/STD, LTD)etc. were just the beginning.  Well, the mystery is starting to clear up with December 18th being the go-live date, providing a more generous benefit increasing from the current 15 weeks to 26 weeks.

So, what does this mean for group disability plans?  There is still EI reform happening and more details are expected in the coming weeks and months specifically around the STD rate reduction program (this only applies if you have a formal STD plan and meet the qualifications).  We’ll watch and share more about this as it comes out.

Should you change your long term disability benefit as a result of this change?

There are a two primary options for employers to consider.

1.  Keep your existing LTD waiting period of 112 or 119 days.  This will provide an LTD benefit 2 months before the EI ends and in most cases, will provide a higher benefit period than the EI benefit maximum.  Insurers do a pretty good job of getting people back to work, so the earlier intervention should help with better outcomes. The downside is that there could be a duplication of EI and LTD payment, which the employee would have to repay (but the LTD benefit is higher so not a hardship).
2. Amend your plan to match the new EI sick benefits. This would delay your LTD benefits from 4 to 6 months.  A small rate decrease would be experienced (~3-7%), but staff would have the reduced benefit that EI offers.  This would also delay the LTD insurer from getting involved, which can make rehabilitation and return to work harder in some cases (early intervention is always better).

The decision will be unique to each employer’s situation. Some have no LTD benefit, so no changes are required. Some insurers will change all their plans one way or the other while others will leave it as is, but most are expected to allow employers to choose.

There is more info on the release below and we’ll be in touch as more information becomes available.

https://www.canada.ca/en/employment-social-development/news/2022/11/government-of-canada-improves-sickness-benefits-under-the-employment-insurance-system1.html

As we approach the end of November, the end of the pandemic and with so many wanting teams back together in real life, the idea of holiday parties comes up.  I saw this note from E2R ( an HR consulting firm) and thought a good reminder of items employers should consider. 

I’ve spent the last few weeks running and speaking at the CGIB educational events in Toronto, Calgary and Vancouver.  We’ve had employment lawyers speak at each of them on a number of topics employers face when it comes to benefits and how they handle them at termination. The one resounding theme that arose was the need for current up to date employment contracts.

Every employee /employer relationship has an employment contract, it’s only a matter if it is written or oral. Written is always preferred as it clearly states how the parties enter into the contract (pay, vacation, etc.) and how they exit (termination pay, benefit extension (or not) etc.).  This can prevent issues when the employment comes to an end.

In Ontario, the courts have ruled that having items like “non-compete clauses” in your contract can render the entire document invalid.  This can cause issues if you terminated a 20 year employee (as en example) who had a written employment contract that had both a non-compete and a termination clause that said that the employee would be paid 6 months of base pay only on being severed.  The non-compete clause would nullify the remainder of the contract leaving the employer responsible to the common law period (as much as 2 years) and could also include items like bonuses, benefits etc.  This can be corrected by reviewing these contracts with an employment lawyer and ensure they are up to date and enforceable.

The article below provides an example of how things go wrong even when written with the best intent.  Please consult an employment lawyer for advice to create enforceable contracts that are specific to your business and particular situation.

“Termination clauses can no longer be seen or read in an isolation of each other – they have to be read as a whole, so employers have to be very careful in reviewing their employment agreement templates from beginning to end, and ensuring that no provision of the agreement, whether it deals with termination or not, infringes on employees’ statutory rights to notice, severance pay, and benefits continuation under the under [employment standards legislation].”

READ ARTICLE