Liaison June 2010 – VOLUME 13, ISSUE 1
on a screen near you:
Desjardins Financial Security (DFS) just launched a
brand-new version of its website, dfs.ca. The new site
strikes a ﬁne balance between form and function, with
simple, streamlined access to secure sites and forms and
a special section for group advisors.
Quick, easy access
One of the reasons for revamping dfs.ca was to make it easier to access our
forms and secure sites. Now you can jump directly to these resources from
the homepage. And as for forms, our new interface has selection buttons
and filters that make it easier to find the document you’re looking for.
Other tools have also been added to make it easier to navigate:
• Improved search function
• Interactive media area
• RSS news feed
• More visuals
Continued on page 3
that is music to
DFS is holding the It’s Music to my Ears!
contest from February 22 to November 29,
2010, all across Canada. As part of the contest,
eight names are drawn at random on the last
Monday of each month and the lucky winners
each receive an Apple iPod touch!
The contest is designed to encourage group
insurance plan members to sign up for DFS’s Direct are you?
Deposit and Electronic Notice service. Promo leaflets
Desjardins Financial Security
advertising the contest will be included with explanations
and the Canadian Mental Health
of benefits and claim cheques sent out during the contest period.
Association invite Canadians to
A total of 80 plan members who sign up for the Direct Deposit and Electronic measure their stress level by
Notice service will receive an Apple iPod touch. People who have already taking the Mood Detector test at
registered for the service are automatically entered in the monthly draws as well. www.mooddetector.ca, or on the
Canadian Mental Health Facebook
Contest information and rules can be found on a special promotional webpage: page. A dedicated link has also
www.dfs.ca/iPod_contest. The names of the winners, along with the names been posted on the Health is Cool!
of their employers, are posted there each month. A message also appears in Information Centre to allow group
the What’s New section of the secure websites for plan members and plan plan members to access the Mood
administrators. Detector test.
Plan members can register for the Direct Deposit and Electronic Notice Service Canadians can also get some tips
at DFS’s secure website, www.desjardinsgroupinsurance.com, or by filling on how to enhance their mental
out the form included with their explanations of benefits and claim cheques health by subscribing to the National
(also available at the promotional website). Mental Health Week’s Twitter
The Direct Deposit and Electronic Notice Service not only simplifies the process
for plan members, but it’s also a green choice. It helps cut down on paper
waste, as health and dental benefits are automatically deposited into plan
members’ bank accounts. This secure procedure:
• Avoids postal delays
• Eliminates the risk of a cheque being lost, damaged or stolen
• Prevents plan members from having to visit a financial institution or an ATM
to deposit their cheque
With the electronic notice system, plan members receive convenient email
updates about the status of their claims. If they want an explanation of benefits
or other information, they can check out their insurance file online at DFS’s
secure site at their leisure.
Expat PLUS – A new insurance Group insurance
solution for expatriate employees made simple: the
Plan members often find it difficult to find their way
through the various types of coverage, definitions and
clauses that make up their group insurance plan. To help
them out, DFS has created a series of documents: the
Find out more about series. These documents provide
plan members with useful information so they can make
more efficient use of their plans.
The series has already covered topics such as generic
Aware that expatriate employees are valuable assets drugs, optional life insurance, and the coordination of
and represent an important investment for companies, benefits. In the coming months, more topics will be
Desjardins Financial Security has partnered with added to the list.
XN Financial Services® to provide health insurance to its
group clients with employees working abroad. The documents can be found online at the Health is Cool!
Information Centre, which can be accessed through our
A partner of choice, XN Financial Services® has created secure site for plan members. Printed copies of these
a niche market for itself by focusing exclusively on the documents are also available to order. Please talk to your
protection needs of these expat employees. Its products group insurance representative for more information.
are supported by the latest technology, a global service
centre that’s available 24/7, and strategic health and
The Expat PLUS program is a comprehensive solution
designed to meet the health insurance needs of Canadian
expat employees, as well as local and foreign nationals.
If you have any questions about our expat insurance offer,
feel free to contact your advisor or service representative.
Continued from page 1
Now playing on a screen near you: This new section is one of the new features we’ve introduced
to make dfs.ca better than ever. It will continue to evolve
the new dfs.ca website based on the feedback we receive, and as new contents and
tools become available.
A dedicated section for group advisors
A dedicated section has been set up especially for group Tell us what you think
advisors who want to find out more about DFS. This section We’d like to hear what you think about our new website. Write to
brings them directly to our service offer, promotional us at firstname.lastname@example.org. If you have any questions about how
materials, information bulletins, summaries of employee the new site works, or if you’re having trouble finding what you’re
benefits legislation for each province, and much more! looking for, call us at 1-866-838-7553.
How does DFS manage healthcare
fraud and abuse?
To answer this question, we need to understand how
important it is to properly manage abuse and fraud. When
the number and amount of unjustiﬁed claims go up, so do Auditing involves verifying the nature of the claims submitted,
the costs of group insurance plans. treatments received, etc. It’s a complex procedure that takes
Healthcare fraud and abuse must be carefully managed
to protect the integrity of the plan. At DFS, this process The time required to perform an audit depends mainly on:
is divided in three parts: prevention – detection –
intervention. • How willing the parties are to cooperate
• The quality of the information received
DFS protects the confidentiality of personal information at all
The prevention of fraud and abuse is an integral part of DFS’s times, which can prolong the process.
quality assurance program. Thanks to special training, our claims
analysts learn to recognize irregularities or “red flags” that can be When fraud or abuse is clearly demonstrated, the following
signs of abuse or fraud. corrective measures may be taken:
Under this program, a sample of claims is analyzed to identify • Suspension of benefit payments
those that need to be examined more thoroughly. Electronic
• Denial of subsequent benefit claims
claims (such as dental and drug claims) are subjected to system
verifications. • Recovery of benefit payments
Controls are also integrated into DFS’s claim processing systems to • Prosecution
prevent overpayments and detect duplicate claims and overbilling,
while applying the parameters and maximums that apply to group If you have any questions or comments about this article,
insurance contracts. write to us at email@example.com. To find out more about
fraud and abuse of group insurance healthcare plans, visit
Detection the Canadian Health Care Anti-fraud Association’s website at
DFS also has a dedicated team of analysts whose job is to look
into claims that contain irregularities or “red flags”.
The team also keeps a close watch on files that show large benefit
payments, to make sure that the claims are justified and that
contract parameters are correctly applied. The team also monitors
all possible sources of abuse or fraud, including professionals and
Audit procedures are only initiated after a file has been carefully
examined, and after a risk of fraud or abuse has been ascertained.
A few reminders…
Disability insurance claims: documents Premium payment during Short Term
sent by fax Disability
To speed up disability insurance benefit payments, It is important for plan members on Short Term
employers and employees fax us supporting documents Disability to continue to pay their premiums to
required to process claims, such as the Employer’s or the maintain their group insurance coverage. In case of
Attending Physician’s Statement forms. a refusal, DFS sends a letter to the plan member,
detailing the consequences of this refusal and
Documents sent by fax for this purpose are legally requesting premium payment by a specified date.
acceptable. It is not necessary to forward the original
documents by mail. However, you should keep the Refusal to pay premiums may have the following
original documents for a minimum of 12 months, in consequences:
case verifications would become necessary. • Cancellation of coverage, subject to any advanced
notices indicated in the contract;
• Termination of disability benefits.
Please contact our Customer Contact Centre to get
more information on this subject.
Send us your questions
Have any questions about group insurance plan?
Feel free to email your questions to us at
firstname.lastname@example.org. In the upcoming issues
of Liaison, we will answer some of your questions
in the ADMINexpress section.
Managing plan costs
The management of group insurance plan costs continues to be a hot industry topic. For this reason, we are pleased to
present you with two articles about it: one deals with why costs increase and the other with what can be done to help
According to various industry sources, group insurance Inflation, the nature of the drugs people use and the therapies
costs are rising by 7% to 15% 1 each year, outpacing the available are the main sources of the increase. Treatments that
rate of inﬂation. increasingly favour the use of speciality products and biologic
drugs that can cost several thousands of dollars are one of the
The key factors behind this trend are an aging workforce, big cost drivers.
a higher incidence of disability, rising drug usage and costs,
and the shifting of costs from the public to the private sector. Shifting of costs from public to private sector
In the past 20 years, we have seen public plans gradually
Aging workforce phasing out certain types of medical expenses, shifting the
While mass retirements are expected in the coming years, a responsibility onto private plans. One example is the portion of
poll conducted in June 2009 2 revealed that 55% of employers paramedical costs assumed by private plans, which grew from
believe their employees will work beyond their normal 54% to 76% during this period.7
retirement age in order to recoup the financial losses incurred Legislative changes concerning prescription drug prices can
during the last recession. also shift costs to private plans. In addition, certain expensive
And while this situation may temporarily solve the labour drugs and devices, not covered by provincial plans, may be
shortage problem, it will also drive group insurance plan costs covered by private group insurance plans.
upwards. On average, older workers use more expensive drugs The opening of private clinics for the injection of biologics,
needed to treat cancer, rheumatoid arthritis and cardiovascular combined with shorter hospital stays, is also contributing
conditions. to the transfer of costs to private plans. For example, drugs
administered in a hospital setting are fully reimbursed by the
Higher incidence of disability public plan but when administered in a private clinic, these
According to Statistics Canada, the number of days lost due drugs may become payable by private plans.
to illness or disability rose from 6.6 days in 1998 to 7.9 days in
2008.3 This increased rate of absenteeism is largely due to a Finding solutions
higher incidence of mental and nervous disorders. In conclusion, the higher incidence of disabilities, growing
The economic insecurity that marked 2009 in particular caused medical expenses and rising drug costs are putting more
workers’ stress levels to rise, resulting in higher incidences and more pressure on employee benefit plans. That’s why
of absenteeism and long-term disability.4 According to the companies are looking for ways to better control costs without
national Health is Cool! survey published by Desjardins losing their competitive edge. Businesses are therefore looking
Financial Security in 2009, 35% of employees said they were for solutions that will help them achieve this goal.
more stressed out this year than they were a year before.
Increased drug usage and costs
Drug usage and costs have been escalating over the past
few years. Between 2003 and 2008, the average number
of prescriptions per person grew from 10 to 11.7 5, a 17%
increase. The cost per prescription also went from $47.61 in
2003, to $59.69 in 2008, a 25% increase. 6 1
Daudelin, Alexandre: Optimiser la valeur de l’assurance collective, Avantages,
July 17, 2007.
Effect of the Economic Crisis on HR Programs, Canadian Edition, Watson Wyatt,
Work Absence Rates: Statistics Canada, 2008.
Worb, Michael: Behavioural Shift, Beneﬁts Canada, January 1, 2010.
ESI Canada 2008 Drug Trend Report, 2009.
Boisvert, Michèle: Protection des soins paramédicaux dans le cadre des régimes
collectifs, Avantages, April 27, 2007.
Current economic conditions are forcing employers to provide information to make employees aware of benefit
tighten control over their costs, including those related to costs and promote behaviours that encourage better use of
employee beneﬁts. But with labour shortages looming, the plan. Employers will likely step up these awareness-raising
this is no easy task. efforts in the coming years.
How will employers control plan costs and maintain their Revising plan parameters
competitive edge on the job market? Key strategies include In the past few years, a growing number of employers
health promotion initiatives, employee assistance programs, have revised their plan parameters. According to a recent
employee education and accountability, and revision of plan study,3 between 20% and 30% of group insurance plan
parameters. administrators intend to take some of the following measures:
• Increase the employee contribution
Prevention and health promotion • Introduce a paramedical care maximum
To help their employees focus more on “being healthy at • Reduce certain reimbursement percentages
work”, an increasing number of employers use an integrated • Impose a pharmacy dispensing fee cap
healthcare model that includes: • Introduce managed formularies for drug reimbursements
• their employee benefits plan
• an absence management program Some employers are also moving towards flexible plans in
order to more adequately meet the needs of each individual,
• an employee assistance program generate more employee interest in the plan and better
• health and wellness initiatives 1 budget the benefit costs. The Flexible Benefits in Canada
2009 4 study indicated that 60% of companies had plans
In the 2009 sanofi-aventis healthcare survey, 31% of the with at least one flexible component, compared to 41% in
employees questioned said they had a wellness program 2005. The health spending account is another measure that’s
at work. Of these, 35% said that they participated in the gaining popularity.
Those who hadn’t participated in their programs said it was Conclusion
mainly because of lack of time or because they felt they
There are many ways to help reduce group insurance plan
didn’t need it. Based on these results, employers may want to
costs. The goal is to choose the strategies that will suit the
concentrate their efforts more on offering employees practical
employer’s circumstances best. Employee benefits advisors
initiatives and choose to use incentives.
can help in this situation, with the cooperation of the insurer,
Right now, it is estimated that 24% of employers are offering by providing reports on plan use. With this information,
incentives as part of a wellness program. The most popular employers can implement the most appropriate and efficient
of these are employer/employee cost-sharing of fitness centre measures that will produce the best results in the short,
fees and rewards. The use of incentives may become more medium and long term.
widespread in coming years, as 24% of employers said they
planned to use them as a way to increase participation in
Employee education and accountability
Employers are always looking for ways to encourage
employees to take responsibility for their health, and to
incorporate employee accountability into their benefits
package. Apart from a description of plan benefits, they also
Swartz, Mark: Canadian Salary and Benefits Trends in 2010, monster.ca.
White, Jody: Culture of health emerging, Beneﬁts Canada, January 20, 2010.
Aon Consulting Benefit Trends Survey, 2009.
Flexible Benefit Plans Control Costs, Meet Diverse Needs, and Attract and Retain
Employees, Hewitt Associates, October 14, 2009.
Sun Safety for All, from Vacationers
to Outdoor Workers
This article is taken from the Health is Cool! Information Centre. The Centre contains numerous articles on work-related health and
wellness topics. The Health is Cool! Information Centre can be accessed through the DFS Plan Member secure site.
Whether you work outdoors or you just want to take advantage of the great weather to enjoy various outdoor activities, take a
few minutes to learn about sun safety.
Did you know?
You can get sunburn on a
cloudy day. Up to 80% of
the sun’s rays can penetrate
light cloud, mist and fog.
The advice provided below applies to everyone regardless of age or ethnicity.
• Avoid needless exposure to the sun, especially between the hours of 11 a.m. and 4 p.m. when the sun’s UV radiation is at its
• If possible, adjust your work schedule so you can start earlier.
• Protect your eyes by wearing UV blocking sunglasses.
• Select shaded areas for outdoor activities; seek shade during coffee breaks and meals.
• Clothing such as a broad-brimmed hat, long-sleeved shirt, and long pants can protect your skin. Tuck a handkerchief under the
back of your hat to help prevent sunburn on the neck.
• If you can’t cover up, use a sunscreen containing a Sun Protection Factor (SPF) of at least 15. We even recommend that workers
who spend long periods outside use sunscreen with an SPF of 30 or more. Make sure your sunscreen offers both UVA and UVB
protection. Re-apply every two hours and after swimming or sweating profusely.
• Some medication can make skin more sensitive to UV rays, consult your doctor if you have any questions.
• Don’t let infants or young children play or sleep in the sun in a playpen, carriage, stroller, etc.
• Get children used to wearing sunscreen, paying particular attention to the most exposed parts – the lips, face, neck, shoulders,
back, knees and tops of feet.
• People can use both sunscreen and insect repellents when they are outdoors to protect their health. Follow the instructions on the
package for proper applications of each product. Apply the sunscreen first, followed by the insect repellent.
For more information on safety in the sun, visit the Health Canada site.
Sources: Health Canada Canadian Dermatology Association – Article Sun Safety for Outdoor Workers.
Travel insurance required
to visit Cuba
Since May 1, 2010, the Cuban authorities require all travelers to have travel insurance with medical expense coverage
upon arrival in Cuba. Anyone arriving without it will be required to purchase coverage on site.
Acceptable proof of insurance
The Cuba Tourist Board has indicated that provincial health insurance cards are acceptable proof of insurance.
We therefore recommend that all plan members and eligible dependents have these cards on hand when they arrive
DFS insurance cards that mention Travel Insurance are also proof of valid medical coverage, as the Cuban government
has recognized DFS as an accredited insurer. However, only plan members can use it as proof of insurance, since their
name is the only one appearing on the card.
Travel insurance coverage
As provincial health insurance plans reimburse only a portion of expenses incurred for medical and hospital services
provided outside Canada, travellers should have travel insurance to avoid paying high out-of-pocket expenses in the
event of illness or accident. Before visiting Cuba, plan members should determine if they and their eligible dependents
are covered by travel insurance through their group insurance plan.
People insured under DFS plans should always keep their DFS insurance cards (supplied with their insurance certificates)
handy as they display the numbers to call in the event of an emergency. The first thing to do if they, or one of
their insured dependents, become ill or has an accident is to call the number on the card so the Travel Assistance
representative can arrange for their care.
R X ID
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New Sales and Service Employees
Roxane Pronovost, Administrative Assistant Annette Lambert, Sales Support Director
Isabelle Désy, Implementation Consultant Karen Bierman, Implementation Consultant
Catherine Giroux, Sales Support Director Catherine Toussaint, Implementation
Susan Gagnon, Regional Director, Sales, Consultant
Broker Market (Quebec) Afroditi lenco, Service Representative
Mélissa Tanguay, Sales Support Advisor Steve Laberge, Sales Support
Liaison is a publication of Desjardins Financial Security. It is published on a semi-annual
basis and distributed throughout Canada to our Group Insurance Plan Administrators and
Representatives. Liaison is also available on dfs.ca.
Desjardins Financial Security – Group and Business Insurance
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| MONTREAL 2, complexe Desjardins, Montréal, Québec, H5B 1E2, 514-350-8700
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Edition: Marketing and Communications, Group and Business Insurance
Layout: Advertising Promotional Activities Department
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