Green Shield Canada is launching a new benefits product, which will focus on drug coverage and mental-health support and eliminate coverage for massage therapy.
The new plan, called SMARTspend, will include a managed drug formulary with 100 per cent coverage and no dollar caps, digital mental-health support options, health coaching from pharmacists and dietitians and vision and dental benefits.
Coverage for massage therapy is Green Shield Canada’s most popular and costly paramedical service, according to a press release, which noted the insurer will spend the money saved on issues such as chronic disease and mental health.
“To give some background, for decades, the majority of Canadian full-time employees have had access to employer-sponsored health benefits plans, typically with a standard design — drug and dental coverage and a host of miscellaneous health services and devices,” said David Willows, chief innovation and marketing officer for Green Shield Canada, in the release. “But these plans have evolved very little over that time.
“Yet the response to these challenges in the world of health benefits has been muted. The few attempts at change have fallen short, including capping the annual drug spend per employee, potentially cutting off employee access to expensive, but potentially life sustaining or saving drugs. What we have not seen is a holistic look at all the costs contained in employer-sponsored plans, and a measurement of the ultimate value they provide by looking at the best available evidence from scientific literature.”
Increase in chronic diseases, the focus on mental illness and the impact of expensive drugs have generated momentum to re-evaluate health benefits, noted the insurer.
The new plan also removes coverage for six- and nine-month dentist recalls, which the company says is unsupported by research, and pushes all recalls to 12 months, as well as copayments and deductibles. It also includes step therapy for proving a clinical need for expensive drugs.
Plan sponsors will have the option to add health-care spending accounts to cover massage therapy, medical devices and other services, according to the press release. As well, plan members can accumulate additional funds for their personal and health-care spending accounts by tracking steps, setting medication reminders and tracking blood pressure through their plan sponsor’s online portal.
“Real change requires meaningful movement away from traditional plan designs and the courage to explain the reasons why to employees who have become accustomed to freely accessing a host of benefits that they definitely like but do not necessarily need,” said Willows.
“It is GSC’s hope that this new SMARTspend plan design, and the conversations it spurs, will provide a host of ideas for employers, benefits consultants and insurers to start a collective journey towards health benefits plans that better embrace concepts of health research and evidence, clinical outcomes and ultimately, value.”