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Benefits and Employer Liability are complex and detailed. Your advisor should be reviewing these complexities before the fact and not trying to fix a problem that could be avoided.

The attached Group Benefits Administrative Check List and the HR Roles and Responsibilities Check List are each designed to help pre-empt problems.

If you’re not carrying on a conversation with your Advisor on a regular basis about the items and issues in the attached checklist, are you getting full professional service?





  • Review Benefits Contract
  • Ensure all contracts include a termination clause regarding the company policy on employee benefits.
  • Ensure contracts are clearly worded regarding employee and employer premium deductions.
  • If your plan includes CostPlus or Medical Reimbursement Plans, ensure contracts include verbiage clearly stating a defined amount and any eligible classes.


  • Obtain all necessary benefit enrollment forms as well as any sign-off required for benefit deductions (if applicable).
  • Supply employee with copies of benefit booklets and forms (either hard copy or via e-link), as well as links to apps, FAQ for plan members and any necessary phone numbers for plan carriers.
  • Set a calendar reminder for yourself and employee to connect prior to probation ending (if applicable) to ensure everything is in place for benefits to begin.


  • Ensure all life events are reported to the carrier ASAP. i.e. Change of name, salary, job title, class, full-time status, employment status (maternity leave, termination, etc.).
  • Employees must submit change forms for the following:

– Life events (marital status change, birth or adoption of child, etc.)
– Change of beneficiaries
– Sick leave (LTD/STD)
– Retirement (Do benefits stop? Coverage changes – if applicable)
– Change in provincial coverage
– Co-ordination of benefits with spousal plan
– Leave of absence {extended vacation (beyond 4 weeks), maternity/parental leave, compassionate care, ESA leave, etc.}
– Opt in/out of health/dental plan
– Death of an employee or covered dependent

    • Termination: (obtain and provide coverage end date to employee). Consult with corporate lawyer if needed for the following:- Quit/Resigned
      – Termination with cause
      – Termination with no cause
      – Temporary layoff (may need LOA – check with carrier for rules)
HR Roles and Responsibilities Checklist

 HR/Administrative Responsibilities 

    • Add/Remove employees (avoid late applicants) 
    • Update employee information (job change, hours, payroll, etc.)
    • Billing and payment of plan 
    • Employee eligibility 
    • Excess and conversion coverage (you must notify employees of eligibility)
    • Renewal meetings/Plan change meetings
        • 4 months prior to renewal – review
        • experience reports and look for gaps
        • 2 months prior to renewal – initial proposal will be sent to Advisor (reach out for a copy)
        • 30-45 days prior to renewal – meet with Advisor to discuss:
                 –  If the plan still aligns with company philosophy and policies
                 –  Is the plan sustainable for the future of the company
                 –  Does the rating align with the experience reports – negotiate if needed
        • Ensure you understand your current plan coverage
        • Consider employee surveys at mid-point of the year to see likes/dislikes and identify gaps
        • Ensure plan reflects your current employee situation

The following is a breakdown of important considerations when creating or negotiating a benefit plan. 


    • Are Life, AD&D, Critical Illness and Dependant Life taxable if paid by the employer? 
    • Is LTD set up to be payable by the employee or employer. If Employer paid, the benefit is taxable in the hands of the employee. If employee paid it is non-taxable, or, if paid by the employer but the premium is added to their income as a taxable benefit (recorded monthly), then it is tax free? 
    • Is cost-plus avoided to prevent possible double taxation? 

Liability and HR 

  • Ensure there is a policy in place for retired employees and their benefit entitlement 
  • Is there a policy for disabled employees? i.e. “After 24 consecutive months of being on LTD all health and dental benefits will cease. During the time of being on LTD the employee is responsible for their portion of the plan premium and if the employee does not pay their portion the coverage will lapse.” 
  • Is there a policy in place for an inactive employee being able to carry benefits? 
  • Ensure there is a policy in place for terminated employees and a benefits continuation formula. Have you discussed this with the insurance company? They decide whether to continue coverage OR NOT! For this check with the policy carrier for any rules they may have underwritten, or for approval to offer this option. Obtain written consent from the carrier in advance of offering the coverage and ensure it clearly states what is and is no longer included. i.e. “Dental and health benefits will remain in place for 30 days from date of termination, however LTD is no longer offered.” 
  • Ensure all income information is current for each plan participant if pooled benefits are offered. Such as, LTD or Life are a function of income i.e. one times employee salary. 
  • Ensure all employees are made aware of eligibility for coverage above the non-evidence maximums, and how they will go about applying for the additional coverage. IF you have employees who have applied, what are the results, and have they been documented? 
  • If an employee has opted out of health and/or dental benefits due to spousal coverage, have they signed a waiver and provided other carrier information and policy number? 
  • Are all eligible employees enrolled for mandatory benefits subject to the contract’s participation requirements? 
  • Are all eligible employees (after probation period) enrolled within 31 days to ensure there are no late enrolment risks? This also includes and status changes such as life events including marriage, divorce, birth of a child, etc. Failing to do this within the timeframe could result in an increased premium or declined coverage for the employee. 
  • Ensure there is an Administrative Error rider included in the Corporate Liability Insurance the cover any mistakes such as missed or late enrolment. Discuss this with the corporate lawyer and add if needed. 
  • Do you have the most current benefit booklet available for employees? Obtain copies both in print and electronic so updates can be communicated to employees in a timely manner. 
  • Is there a documented policy that covers employer liability when the company changes a provision or the provider of the insurance policy? Discuss if this is a need with your corporate lawyer. 

Privacy & Confidentiality 

  • PIPEDA is designed to protect a person’s privacy but can restrict the information that can be reported to an employer. Ensure you are aware of any changes to PIPEDA and what is allowed to be in an employees file. 
  • Claims should be submitted directly to the Insurer or paid through a direct card, and there should be no copies submitted to the employer or kept in the employee files. 

Administrative Issues: 

  • Ensure all salary changes and terminations are reported promptly. 
  • Are all premiums up to date under a fully insured plan? Do you have adequate claim reserves if you have an ASO plan? – Please note lapsed premiums or a negative claim reserve can result in reimbursement suspension and cause the employer to become the insurer. 
  • Is it documented that benefits offered are during maternity/paternity leave as required by legislation.  
  • Are original enrolment forms maintained for changes and termination forms? Ensure this is completed in accordance with any PIPEDA rules. 
  • Is there a documented policy regarding students maintaining benefit coverage while attending school out of country? 
  • Ensure all over-age dependants who qualify for benefits have completed the necessary documentation within the necessary timeframe. 
  • Ensure all participants have provincial health coverage as their first payer. 
  • Ensure all absences due to LTD or WSIB have been reported to your Insurer. – Typically after the first 30 days of absence. 
  • Ensure there is a documented policy for employees to review regarding the Out of Country coverage that may be included with the plan when travelling. – Some policies exclude countries that are unstable. Reminders should be sent to employees when they notify you they will be travelling so they can contact the insurer prior to leaving to verify coverage. 
Group Renewal Template Example:

Every year your benefit contract with your insurer will renew. Having a clear, concise and effective presentation that illustrates the factors influencing your benefit pricing is essential. We have crafted a document that offers you clarity in your understanding of your Group Benefits pricing. This document helps us understand how the insurance company has derived your pricing and is constructed in such a way that we can strategically call into question insurance company pricing, risk assumptions and administrative back office costs.  It forms the basis for our constructive conversation around any strategic chnages that can benefit you.

Please click on this PDF to see an example of our renewal template.  Thank you.


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“No matter how expert you may be, well-designed checklists can improve outcomes”

Steven Levitt

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