Defining what is Eligible
CCRA interpretation bulletin IT-519R2 describes the most generous medical and dental coverage permissible by law. Link: www.benefits.org/form/it519r2.htm

Employers usually fine-tune the benefit plan to exclude certain products and services. For example, medicine dispensed by a naturopath can be excluded by only covering medicine dispensed by a pharmacist. Coverage can be further restricted by only including medicine that cannot be dispensed without a prescription. The plan can be even further restricted by only covering medicine on a specified formulary (list).

Setting a Reimbursement Level
Employee behaviour can be influenced by varying the reimbursement levels, such as 100% coverage for preventive dental services 50% for restorative.

Setting a Spending Limit
Few employers have the financial resources to provide unlimited coverage. Most set spending limits on specific categories of benefits (drugs, vision, dental, paramedical services, etc.). Some employers take a different approach and set an overall spending limit without restricting the eligibility of expenses or reimbursement level (health spending account). Link: www.benefits.org/hsa/

Opportunity
Review the cost containment strategy of your present benefits program in light of the results that it is generating. Are your costs contained?

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