The majority of RWAM's in-force premium is renewed on a prospectively rated basis. This means that the insurance provider reviews your rates based on the actual experience incurred.

Adjustments are made to your pooled rates (Life, A.D.& D., Dependent Life, Short Term Disability & L.T.D., and Out-of-Canada/Province) to reflect changes in demographics, mortality and morbidity. RWAM reviews each group that it administers, and assesses the extended health and dental care based on the actual claims experience incurred by the group. A determination is also made on the amount of credibility that should be attributed to the group’s experience. This approach helps to ensure that groups with positive claims experience are renewed favourably, and that groups demonstrating high levels of claims experience are more in line with the usage they are exhibiting. Having said that, we review renewals with an eye to removing a claim which is a one-time occurrence. RWAM does not seek to recoup past losses.

RWAM has a reputation for being a fair renewal underwriter. This reputation has been earned by understanding that nothing is entirely black or white. Client retention requires that you live in the grey, and our ability to put ourselves in your shoes is what sets RWAM apart.

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Administrative Services Only plans are becoming more and more popular. In an ASO plan, the employer reduces the expenses associated with providing certain benefits - typically extended health and dental care. In exchange for this, they take on all of the legal and financial responsibility for providing these coverages.

Why consider this? Because plan sponsors recognize that benefit costs are taking up a larger portion of their bottom line. Self-insuring employers gain greater control.

But what if we could reduce or remove some of the reasons for premium increases?

• expenses associated with administering the plan
• the impact of higher IBNRs (reserves), and
• risk charges

Employers gain greater control, and at renewal, concerns about inflation and government down-loading are mitigated because the plan sponsor is able to determine whether premiums should be adjusted based solely on their incurred claims.

ASO plans have more flexible funding choices. The deposits for health, dental and short term disability could be funded monthly; they could be set up with billed rates similar to a traditional plan (single/family); or they could be structured in an in-arrears arrangement, where payments are based on actual paid claims and expenses.

Employers need to understand that whichever method they choose, claims do fluctuate, and so too will their cash flow and liability. However, for the right client, an ASO plan makes sense because it leaves the control where it should be - with the employer.

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RWAM provides group insurance benefits to over 7,600 employees of Home Hardware Stores Limited and its Dealer Network.

Participating Dealer stores benefit from the volume discount-buying power due to the large number of employees insured under the plan.

This guarantees the most competitive product on the market today. Add to this the financial strength and security of the self-insured Home Hardware Trust and you have a winning combination.

• The Home Hardware group insurance program is truly unique and competitive
• RWAM’s services are second to none
• Dealers receive the added convenience of being billed directly through their store account

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Stop Loss Pooling is a way for clients to limit the risk of large health care claims driving up their health insurance premiums.

Normally, when RWAM calculates a renewal, we take into consideration the claims experience in the plan for the previous 12-month period. The inclusion of Stop Loss allows us to continue to do this, but in addition, we remove any health claims for a plan member or dependent in excess of the Stop Loss Pooling level from the previous year’s experience calculation. Extended health claims up to the Stop Loss ceiling are used in the renewal rate calculation. RWAM then ‘pools’ any amount over this threshold through the Stop Loss insurer.

We are seeing larger drug claims, particularly for new drugs, which have increased the interest in Stop Loss coverage.

Here are some examples:

• Remicade for Rheumatoid Arthritis, Psoriatic Arthritis, and Crohn’s Disease to name a few - $27,000 to $35,000/person/year
• Rebif & Avenox for Multiple Sclerosis - $20,000 to $25,000/person/year
• Rebetron for Hepatitis - $30,000/person/year

Stop Loss Pooling limits a plan’s exposure to catastrophic drug and other health claims, thereby allowing for a more stable premium structure for clients.

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Specifically tailored program for self-employed individuals with 5 or less employees.

Traditionally, self-employed individuals have had few options. Some insurers do not offer an individual benefits plan due to the potential high cost of insuring one person’s risk. RWAM’s ‘1 two 3’^TM program offers a clear alternative.

• The plan includes mandatory Life, Accidental Death, Disease and Dismemberment, and Extended Health Care (including Out of Country benefits). Dental and Long Term Disability benefits are optional.
• There are Cost Plus capabilities to ensure that additional health and dental claims can be covered in a tax effective way. You should discuss this option with your corporate accountant.

^TM Trademark of RWAM Insurance Administrators Inc. All rights reserved.

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A Health Spending Account (HSA) is an individual employee account that provides reimbursement of eligible health care expenses.

They provide employers with a convenient way to deliver tax-effective compensation, to budget their cash flow, and to provide employees with greater choice.

At the start of the plan year the employer determines how many dollars will be allocated to the account. When an expense is incurred, the employee submits a request for reimbursement to the administrator (RWAM) who adjudicates and issues payment from the account. Payments from the account represent non-taxable income to the employee.

The biggest advantage to a Health Spending Account (HSA) is that it allows health-related expenses to be paid on a pre-tax basis. That is, employees can be given tax-free reimbursement for any eligible medical or dental expenses not covered under their insured plans (except in Quebec, where health and dental benefits are subject to provincial income tax).

To preserve the favourable tax status of the account, employees cannot direct payroll deductions to it (employees may not supplement the plan with payroll deductions because these are after-tax dollars). Funds must come from employer contributions only.

Health Spending Accounts maintain their favourable tax status provided they meet the definition of a “Private Health Services Plan” as defined under the Income Tax Act. The rules for Health Spending Accounts are determined under the Income Tax Act and by CRA Interpretation Bulletins.

Employees can be reimbursed from their HSA for deductibles, co-insurance amounts, or amounts in excess of plan maximums that would otherwise be paid out-of-pocket. Funds in a Health Spending Account can also be used to pay for items not covered under an employee’s group health or dental benefits.

Examples of Eligible Expenses...

• drugs which are prescribed by a medical practitioner and recorded by a pharmacist
• orthodontics
• glasses or contact lenses
• seeing eye dogs
• eldercare for dependents who qualify under the Income Tax Act

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RWAM's easy to use online internet service allows Plan Administrators to process additions, terminations, transfers and changes to your group electronically in real-time, and more importantly, when it’s convenient to you. more...

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RWAM Disability Management has the expertise and information our clients need to take control of disability costs. Our early intervention consultants will provide answers to employers’ most urgent questions: the normal expected claim duration, the potential for long term disability, and the best approach to disability management.

Our Philosophy

RWAM Disability Management believes in working in tandem with our clients and plan sponsors. This co-operative approach allows RWAM’s disability specialists to be part of the team addressing the issues of absence, illness, and injury. A key aspect of our role is to manage the expectations of both the employer and the employee. RWAM Disability Management’s proactive approach is structured to enable optimum recovery with a safe and timely return to work.

Early involvement is the key to getting an employee back to work. We believe that it is our role to be actively involved in helping clients manage their claims by initiating rehabilitation at the first opportunity during the qualifying period.

Early Intervention Program

The earlier support services are offered to an absent employee, the sooner the employee is likely to be able to successfully return to work. It has been proven that intervention can shorten the length of time an employee is absent from work. The program facilitates effective and accurate communication between all parties involved.

Our focus is on ability, not disability. We explore part-time options with the employer when it makes sense to do so, because experience has taught us that employees need to know that they are still a valued part of the organization.

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Simply put, RWAM’s Profit Participation Plan is a funding alternative that allows eligible participating plan sponsors to benefit from the profitability of their insured Group Health or Dental plan. In years when a participating plan sponsor’s Health or Dental plan generates an underwriting surplus they will share in that surplus with the insurer. In years when the plan generates a deficit, the full deficit is the responsibility of the insurer. Clients win both ways!

For the Employee Benefits Advisor, the Profit Participation Plan helps to reduce the emphasis on renewal rates. No margin for deficit recovery is ever included in future rates. Profit Participation is available to any eligible RWAM client or new group that provides insured Health or Dental benefits, has at least 50 employees insured in these benefits, and maintains a combined Health and Dental annual premium of $75,000 or more.

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Through arrangements with Ceridian, Employee Assistance Plans (EAP) are available to RWAM groups with 10 or more lives. Ceridian is a full-service, bilingual employee support program provider. It provides confidential counseling and work-life consultation services that assist employees and their immediate families with personal problems and other concerns.

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Critical Illness insurance has everything to do with living and nothing to do with dying. It's what most people would need should they ever contract a critical illness (e.g., stroke, heart attack, cancer etc.) and as a result, the demand for this type of coverage continues to rise.

RWAM is pleased to offer Critical Illness coverage through ACE INA as a special-risk carrier, whose main focus in the group insurance market is Group AD&D and Group Critical Illness. Our group health plans include a choice of Critical Illness riders that are available as an attachment to the base AD&D plan.

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Through our affinity relationship with eNETPayroll web-based payroll service solutions are available for your organization. For more information on eNETPayroll solutions please Contact our Head Office.

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