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SmallBiz Employee Benefits – “My spouse doesn’t have benefits anymore.”

By May 1, 2019 No Comments

Came across a situation this week where one of my Clients was in danger of being “out-of-step” because their spouse was losing their job…and their benefits!

Up until now, he had elected to waive the Health and Dental Benefits that he provided to his 4 employee company because his spouse had benefits through a much larger company. His spouse’s benefits were very rich with 100% reimbursement for both Health and Dental and much higher maximums than the 80% reimbursement plan he had set up for his employees.

With his spouse losing their benefits because of a re-organization, he came to me asking to go back to his Carrier and get pricing on how much it would be to add his spouse’s benefits plan…just for him and his family.

Unfortunately, one of the “downsides” of a SmallBiz Benefits program, especially in the 2-9 employee companies, is that there tends to be restrictions on what is covered compared to larger companies. So, when I went back to his Carrier and asked them for a price to match the Owner’s spouse’s plan, they came back with very high pricing and a lot of deviations.

I then presented to him his other options:

  • Administrative Services Only (ASO)…he could set this up separate from the Employee’s plan and get 100% of his medical and dental expenses reimbursed. A simple, “Pay as you Play” plan
  • Cost Plus…he could join his Employee’s plan and have any gaps in coverage covered by his Company paying for the Cost of the reimbursement gap plus an Administration charge.
  • Health Care Spending Account…basically the same as ASO above but there would be a hard ceiling on the reimbursement maximum.

I don’t know which way he is going to go…he has to talk it over with his spouse.

Located in Cambridge, ON Sharkey Group Insurance  provides independent Employee Benefits advice & counsel for Small Businesses across Ontario.