September 2021 – When Colin Druhan went looking for a new benefits plan in the summer of 2019, he had three specific objectives. The executive director at Pride at Work Canada, which advocates for LGBTQ2S+ employment and consults with employers to create safer, more inclusive environments for employees, knew his employees needed excellent coverage for prescription drugs, transition-related care and mental health.
The plan he implemented in September 2019 with his new benefits advisor, James Guest of the Winch Group in Toronto, Ontario, member firm of the Benefits Alliance Group, checks all three boxes and then some.
First, co-insurance was set at 90% across the board. Next, the annual maximum for the prescription drug plan was increased to $10,000. “We couldn’t completely remove the cap, which was part of the previous plan, so we negotiated it to be as high as possible,” says Guest. If someone exceeds that amount, they have access to services to navigate coverage through other sources, such as a spouse’s plan, the government or the drug manufacturer.
Druhan notes that all Pride at Work Canada employees belong to the LGBTQ2S+ community, which tends to have higher utilization rates for prescription drugs related to challenges such as managing HIV/AIDS, mental health issues and cancer due to higher rates of smoking. “It was important that we have a really high cap for prescription drug coverage because the cap that we had on our previous group benefits plan was really low and it wasn’t meeting our needs,” he says.
A signature feature of the plan is that it helps cover the costs of gender-affirming care, a piece Druhan says is missing from most public and private benefits plans. Plan members have access to coverage for hormone replacement therapy (HRT) as well as surgical procedures.
“A lot of the procedures that we know for people who are trans to be life-saving are often qualified as cosmetic. We know they are not cosmetic. They’re about affirming one’s gender to align with one’s gender identity,” he emphasizes. “We wanted to make sure that cost is not a barrier for anyone on our team who is trans and undergoing HRT on an ongoing basis or who decides they want to take medical steps to transition.”
Another differentiating element of the plan is that it carves out mental health-related services from the paramedical benefits bucket, with coverage of up to a maximum of $1,000 annually. Coverage for other paramedical services is set at $500 annually per practitioner. “That was really important to us … because we see poor mental health outcomes in queer and trans communities,” Druhan explains.
In addition to a new benefits plan, Druhan knew he had to find the right advisor. He encourages all employers to make sure their advisor can bring forward supports specific to LGBTQ2S+ plan members—or be open to finding out how it can be done. “What I really like about James is that when he doesn’t know what I’m asking, he asks the right questions in order to get the information that he needs to help us best,” says Druhan.
For his part, Guest appreciates how deeply Pride at Work Canada understands employees’ needs. It was a good demonstration of how critical it is to clearly articulate member priorities to build a truly tailored plan. “Individuals are distinct by definition so when setting up a benefits plan organizations should be looking to support their specific employees and their healthcare needs,” says Guest. “Benefits are not one-size-fits-all, nor should they be. Working with an informed benefits advisor, listening to your employees and designing a plan that they see as beneficial to them will ultimately lead to a happier, healthier workforce.”
Drawing upon the resources of the Benefits Alliance Group also helped, notes Guest. “I have access to the top minds in benefits and with their guidance we were able to break new ground with this plan.”
Utilization has increased since the new plan was put in place, a positive sign since it suggests that it’s better aligned with employees’ needs. Druhan also believes leveraging the directory of the Umbrella Mental Health Network, which connects people from queer and trans communities with mental health service providers who are queer or trans, is making a difference.
Financial planning services are the next enhancement for employee benefits. “Of course we have to watch our budget, but we really do see an investment in our employees as a good investment in the future of our organization,” says Druhan. “When I started with Pride at Work Canada in 2014, I was the only staff member. In the past two years we’ve grown from five to 11 and we serve almost 200 companies. I’d like to think that part of that growth is helping people understand that they’re part of a team that really supports them.”
This article is part of The Benefits Alliance Take 5 for Health Benefits. Take 5 is a quarterly initiative that provides a deeper look a the employee benefits space by providing examples, research and case studies on what’s working for employers in Canada.