© Copyright 2006 Rogers Publishing Ltd. The following article first appeared in the May 2005 edition of BENEFITS CANADA magazine.
While the Ontario government toys with reinstating delisted services, sponsors should recognize that covering those services could well be an investment.

I NEED PHYSIO—THE RESULT OF A LINGERING SPORTS injury. But I’m one of those people who has been affected by Ontario government’s delisting of physiotherapy and who—as an over-19 and under 65-yearold resident—must pay for physiotherapy treatment out of pocket.

But what if I chose to forgo treatment, became chronically disabled, and took extended time off work? That’s the question plan sponsors should be asking themselves—and preparing for—in light of the government’s continued exclusionary stance on the physiotherapy, chiropractic and eye exam coverage.

The Ontario government delisted physiotherapy, chiropractic services and eye exams in the May 18, 2004 budget. While flip-flopping on the physio and eye exams in the past several months, and reinstating them for certain segments of the population—a move which buoyed the spirits of benefits plan sponsors— the situation hasn’t really improved for employers.

Most employees fall into the non-coverage group(20 years to 64 years)and must rely on the extended health plans from their employers. “You probably have 30% of the population that you would categorize as uninsured,” says Steve Benson, president of Benson Benefits Consulting in Barrie, Ont. “You’re still excluding a significant portion of the population.”

For those employers who don’t cover physiotherapy, chiropractic treatments or eye exams under their benefits plans, the costs of picking up the tab on these services is a non-issue—at first glance. In fact, when the delisting was announced, many employers removed the services from their plans or reduced formerly generous coverage of them.

But indirect costs could come back to haunt plan sponsors. “Most of their costs are not from the provision of the actual healthcare services,” says Christina Boyle, president of the Ontario Physiotherapy Association in Toronto. “What they really lose out on is lost time—both the direct and indirect costs.”

She says sponsors who don’t provide coverage for these services may see spikes in their short-term disability usage and costs. They could have employees who have injured themselves outside of the workplace off work for long periods of time— particularly if their jobs are physically demanding. “If you have someone who is forgoing physiotherapy and they work for an employer who doesn’t provide it and they can’t afford it themselves, they may be taking time off work because they’re not getting treatment,” says Benson.

The trick, says Boyle, is to pay up now—and avoid long-term problems. She says some large sponsors have begun setting up arrangements with local clinics to treat their employees if they become injured. In that way, employees are back on the job sooner and have a lower chance of developing a chronic problem.

Offering the coverage under an extended health plan will also not have as large a cost impact as many sponsors would believe, says Benson. “I would say it’s going to have an impact but not a significant [one]. He says that in extended healthcare plans, most of the premium costs are tied to providing the drug plan—not the result of physiotherapy or chiropractic claims. Benson adds that even if an employer’s chiropractic claims double year-over-year, “it’s not going to [make] a big dent in your costs.”

The next year will likely tell the tale of what happens with claims for these services. And whether those employers who offer coverage will see significant changes in extended healthcare costs. Those who exclude coverage may never know the full cost impact.

So while the government continues to waffle on the issue of whether it will cover physiotherapy, chiropractic and eye exams for the population at large, plan sponsors should weigh the choices before they make their own coverage decisions.

Anna Sharratt is managing editor of BENEFITS CANADA.

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