To market group insurance to small firms, many carriers use the “package” approach. In other words, there are certain fixed combinations of benefits for which the firm and its employees can apply. This eases the preparation of contracts, eliminates some enrolment materials and facilitates billing and claim settlement. Each carrier has its own set of packages, so a broker should become familiar with what the carrier offers.
Claims that were actually paid during the indicated time period.
Paid Loss Ratio
Actual paid claims divided by premiums.
Provincial government plans for payment of prescription drugs to all residents of that province.
Person appointed by an employer to administer a group plan.
Point of Sales Claim Adjudication (P.O.S.)
Employees present a magnetized or “Smart Card” when they purchase a prescription, visit a dentist or other provider. The pharmacist or provider uses a terminal to read the card and access employee plan information. The claim is a verified service and a record is set up for transfer of funds from the insurance company to the provider.
One way to establish a viable relationship between premiums and claims - when covering small units - is to put such units into a common pool and evaluate the entire pool. This means units with fewer or small claims subsidize the units with many or big claims. Pooling is the basic principle of all insurance and should be communicated as such.
Provincial Health Plans
Provincial government plans providing basic hospital and medical care. Some may provide dental coverage.