Most (79 per cent) plan sponsors said they have at least one major concern about their health benefits plan, with this increasing to 89 per cent for employers with 500 or more workers, according to the 2020 Sanofi Canada health-care survey.
The top concerns include drug plan sustainability (42 per cent), dental plan sustainability (39 per cent), absence and disability (32 per cent), use of paramedical benefits (29 per cent) and fraud (28 per cent). Worries over paramedical benefits usage are on the rise since 2018, when 21 per cent of plan sponsors cited it as an area of concern.
For larger employees, rankings of specific concerns became tighter, with drug plan sustainability and absence and disability tied for first, at 39 per cent each, followed by fraud (34 per cent), dental plan sustainability (32 per cent), use of paramedical benefits (30 per cent) and the lack of time for long-term strategy (30 per cent).
Complaints and appeals over denied coverage are an emerging area of focus for plan sponsors, with 20 per cent of respondents saying they’re concerned, up from 14 per cent in 2018.
In a separate question, 51 per cent of plan sponsors said they’re concerned about usage levels of short-term disability benefits and 50 per cent said they’re concerned about long-term disability benefits. Large employers were more likely to say so, at 61 per cent and 59 per cent, respectively.
Fraud also remained a major worry among those surveyed, with 51 per cent of plan sponsors expressing concern about the misuse of health benefits by plan members, suppliers and/or health-care providers, rising to 67 per cent among large employers. Plan sponsors in Quebec were more likely (63 per cent) to be concerned, regardless of size.
“Every dollar you save on fraud is a dollar you can invest elsewhere,” said Dave Patriarche, president of Mainstay Insurance Brokerage Inc. and a member of the Sanofi Canada advisory board. “Advisors sometimes see a scary amount of fraud and not just by the obvious criminals. Plan members misuse benefits and don’t realize it or they rationalize it. They need to know that if they go to a vision provider and ask for sunglasses, that’s fraud. If they go along with their dentist waiving the co-insurance, that’s fraud. And they could lose their job.”
The majority (87 per cent) of plan sponsors said they’re confident in their insurer’s ability to detect and manage fraudulent claims, with 33 per cent saying they’re very confident. Both plan sponsors (77 per cent) and plan members (85 per cent) said they’re willing to get certain products and services, like massage therapy or orthopaedic shoes, from a list of approved providers — and at discounted rates — in order to prevent benefits fraud. However, just 23 per cent of plan members said they’re aware of how to report possible benefits fraud anonymously.