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Group Benefit Plans

Our Group Benefit Solutions

Balancing plan sustainability and member health

Our proven commitment to service and innovative solutions combined with our in-house expertise has helped us to become an industry leader in health services. Medavie Blue Cross offers benefit plans and approaches that set us apart, drawing on decades of innovation and experience. We work with consultants, brokers and advisors to make recommendations tailored to fit each benefit plan’s goals.

Optimal Drug Plan Management

Innovations in providing affordable drug benefits

We help you manage and control your benefit drug costs through our integrated tools and approaches. Instead of spending more money, we search for ways to help you spend more wisely.

Our unique approaches and innovations include:

  • Our own drug adjudication system, providing flexible and customized approaches to managing benefit plans by understanding leading health and claim trends
  • An industry leading health service provider network, ensuring maximum savings to members and plans
  • Integrated in-house technology and health care professionals delivering forward-thinking formulary design

As a group benefits partner, we understand how essential it is to provide affordable drug benefits to our plan sponsors and their members, especially given the rise in prescription drug costs over the past two decades.

Our solution has never been spending more money, but finding ways to spend more wisely. Our Optimal Drug Plan Management approach is providing plan sponsors up to 25% in savings on specialty spend.

Key features of our new investments to increase savings, improve utilization, and enhance the member experience include:

  • Our Patient-first Network: Our enhanced approach to case management facilitates the interaction between the patient support program, physician and pharmacists to proactively manage the program steps for the member from prescription, treatment to renewal.
  • Specialty Pharmacy Agreements*: Patients diagnosed with serious chronic diseases requiring complex treatments can now access a network of specialty pharmacies to ensure they are provided with expert clinical care while delivering additional savings for plan sponsors through contained dispensing fees and markups on targeted specialty drugs.
  • Strategic pharmaceutical partnerships: We have added resources to our Drug Management Solutions team focused on leveraging and cultivating strategic relationships within the pharmaceutical industry.

Read more:

Innovations in Savings and Support (PDF, 507 KB)

Since 1994 our Medication Advisory Panel (MAP) of expert health care professionals has reviewed medications regularly, with the sustainability of your benefit plan in mind.

These internal and external professionals include:

  • Pharmacist consultants, representing hospitals, academia and community pharmacy
  • Medical consultants, including a specialist and a family practitioner
  • Health care consultants and representatives from our Group Product Management and Actuarial Services teams

The purpose of the panel is to:

  • Make monthly review of cost-benefit relationship of new drugs before they are added to our approved drug list – which guides our Special Authorization process
  • Review and make recommendations concerning the benefit status of medications
  • Review information from sources including external specialists, independent organizations, and educational groups to help guide benefit or payment criteria
  • Recommend payment criteria and quantitative limits for medications, when necessary
  • Establish and maintain submission requirements for the evaluation of medications

For over 20 years our Special Authorization process, led by a team of on-staff nurses and health care workers, has ensured that plan members have access to benefits that may otherwise have been restricted by cost.

Our Special Authorization criteria is guided by the health care professionals on our Medication Advisory Panel, which reviews medications and classifies them as needing prior approval, where a set of clinical criteria must be met before the prescription is eligible for reimbursement.

We make sure the prescribed drugs are safe and effective and are being used for conditions the government and the manufacturer have approved.

This approach ensures the patient receives the treatment they need, and the plan spends smart money on a proven safe and effective treatment.

As a natural evolution in our Optimal Drug Plan Management philosophy, since 2013 Mandatory Generic Substitution has been our standard offering for all plans we manage.

Generic drugs are equally safe, proven effective and deliver the same health outcomes as brand name medications. The active ingredients of generic medications are absorbed into the body at the same rate, deliver the same therapeutic effect and can be safely interchanged with typically higher priced brand medications. All drugs sold in Canada must be approved by Health Canada – each product must meet strict regulations and both generic and brand name drugs are subjected to the very same rigorous standards.

With Mandatory Generic Substitution, even if the member submits a prescription with “No substitution” indicated at the pharmacy, the plan will only reimburse up to the lowest interchangeable price. For instances when a medically substantive need occurs and members must remain on the brand name drug, we have developed an Exception Process through our in-house Special Authorization Unit.

Our goal is to minimize duplication and financial risk to our clients. We want to make sure your benefit coverage avoids duplication and reflects the regulations and programs of every province. In 1999, we became the first insurer in Canada to offer clients an automated program of this nature at the pharmacy level.

Our system lets the pharmacist know when a member may qualify for government program coverage. In some instances, we are able to automatically redirect the costs to the government first, while the balance is put through their private plan.

By ensuring our products and services are supplemental to government, we can:

  • Help participants maximize their coverage
  • Better manage group plan costs and existing formularies
  • Prepare for breakthrough medications
  • Protect the long-term viability of health plans

We launched Rx Choices in 2005 to address increasing demand for drug therapies, while controlling group plan costs. Rx Choices is a tiered plan that encourages members to make informed decisions.

Medications are separated into two tiers, and the co-pay varies between the two.

This ensures members have:

  • Access to the medications they need
  • The flexibility to choose options from either tier
  • A plan that rewards wise choices by lowering costs.

Specialty Drugs are offering Canadians with severe illnesses better quality of life, faster return to work, and in some cases, a longer life expectancy. In the past decade, they have become one of the most important opportunities – and challenges – in health care.

Our Patient-First Network, which helps members access these treatments as seamlessly as possible, is one of the most important things we do. And thanks to the strength of our optimal drug plan management solutions, our clients are able to offer affordable, sustainable coverage to their members – when they need it most.

Special focus on supporting members

Under our enhanced approach to case management, Medavie Blue Cross will facilitate the process between the patient support program, physician and pharmacists to proactively manage the program steps for the member from prescription, treatment to renewal.

Read more:

Patient-first Network: Caring support at a difficult time (download PDF, 1 MB)

Health & Wellness

Approximately 1 in 5 members of the working-age population in Canada are living with a mental health problem or illness.

This is why we offer a variety of mental health solutions designed to help you build a mentally healthy workplace that protects your employees and sustains your plans for the future.

Mental Health Resources

Almost 60% of your employees have a chronic disease.

The good news is, we can help—with our new extended health care benefit specifically for chronic disease management. It’s a smart investment today for long term health—for your employees and your organization.

Learn more

Managing Chronic Disease benefit

inConfidence is an employee and family assistance program offered by Medavie Blue Cross. It is a voluntary confidential clinical counselling and lifestyle information service for employees and their immediate families. This comprehensive program provides direct access to care 24 hours a day, seven days a week, 365 days a year. Support is available in person, by telephone or online.

inConfidence also provides a variety of training and educational services for organization leaders and administrators, including management consultations, trauma response and ongoing account and communication support.

Help to keep your plan members healthy with the My Good Health interactive web portal.

My Good Health provides tips and information on:

  • Health conditions
  • Medications
  • Natural health products
  • Diagnostic tests and procedures
  • Healthy living resources
  • Health tools and calculators
  • National community supports

It also includes an interactive health assessment tool designed to give participants an overall snapshot of their health, identify risk factors and provide personalized wellness strategies.

Enhanced package for plan sponsors

The portal is an integrated extension of your health and wellness program, and is co-branded for your organization, including messaging specifically for your plan members.

My Good Health Enhanced provides your organization with reporting, tools, insights and customized data to track areas of concern and implement changes to assist your employees to improve their health. It provides a strong foundation for your wellness strategy and is a powerful resource for designing health and wellness programs that foster a healthy, productive workforce.

Giving your employees access to medical Second Opinion can change their lives. Second Opinion by Medavie Blue Cross provides employees and their eligible family members the opportunity to have their medical files, diagnosis and treatment plan reviewed by specialists at world class medical institutions.

Second Opinion can be accessed through a toll-free number at the member’s convenience.

Read more

Second Opinion Brochure (PDF, 807 KB)

Connected Care provides member-exclusive access and preferred pricing to innovative, convenient health care options:

  • Online Doctors – virtual medical care
  • Personalized Medicine – Pharmacogenetic testing
  • Digital Therapy – Online Cognitive Behavioural Therapy (iCBT)

Connected Care is available only to plan members and their families, either through the Medavie Mobile app or by logging in at Members directly access the Medavie Blue Cross offer pages for the respective partners, with any preferred pricing automatically applied to their purchases at checkout.

The service provides a convenient option for members to find leading health providers who have been selected for offering the best possible quality and security. It enables member education and connection to relevant services, adds value to benefit plans at no additional cost to sponsors, and encourages self-care and member engagement in their health.

Life, Disability and AD&D

We offer a variety of products to build your employee’s finances in order to protect them and their families in the event of an accident, critical illness or death.

There is no way to anticipate life’s unexpected challenges, but we can provide peace of mind through sound financial planning. Our extensive line of products include:

  • Basic group life
  • Dependent life, for spouse and children
  • Optional life
  • Accidental death and dismemberment
  • Critical illness
  • Financial protection against critical illness
  • Group disability

Our group disability plans promote active disability management, minimizing or preventing time lost from the workplace.
We’ll work with you to design a benefit plan suited to your individual needs. Our expert interdisciplinary team includes occupational therapists, kinesiologists, social workers, rehabilitation specialists and registered nurses.

Additional Options

If you want more choices, we also offer the following services:

A Health Spending Account is an effective way to offer plan members the benefits they want using pre-tax dollars (except in Quebec), providing you with the flexibility to meet your members’ unique and varying health care needs. Plan design options include our paperless automatic reimbursement plan where we instantly calculate and process reimbursement for unpaid portions of regular claims (such as co-pays or amounts above plan maximums) without the extra hassle of submitting a separate HSA claim form. In addition, we offer other customizable options to enhance your plan management and ensure greater convenience for your plan members and maximized usage of your benefit offering.


  • Employees can choose where their HSA benefit dollars are spent.
  • Employees can customize their plans to their specific needs.
  • Reasonable medical expenses not reimbursed by any government sponsored or private health care plan are eligible.
  • The HSA can be used to reimburse deductible and co-payment amounts for both medical and dental benefits.
  • Employers can better predict and control costs because the amount allocated to each plan member is pre-defined.
  • Employer contributions and administrative costs associated with the plan may be tax deductible.

Read more:

HSA brochure (PDF, 738 KB)

Cost Plus can enhance your current Medavie Blue Cross benefit plan, providing up to 100 per cent coverage for your key employees.

  • You select the employees who participate
  • Covers benefits not covered under the standard benefit plan
  • Extends to expenses in excess of plan maximums
  • Coverage includes group plan deductibles and co-payments
  • Premiums may be tax-deductible business expenses
  • Benefits may be non-taxable income for the employee
  • Flexible coverage for dependents: coverage may be extended to non-traditional dependents such as parents or grandparents, providing they qualify as dependents under the Canada Revenue Agency Income Tax Act.

Health benefits for a lifetime

With Group Assured Access, your employees and their families will always have access to an affordable personal health plan. This plan contains no exclusions for existing or new medical conditions and members are covered whether they retire, change jobs or their dependents reach the maximum age of eligibility.

Group Assured Access is only available to eligible Medavie Blue Cross group health plan members and their families in Atlantic Canada.

Benefits for your business

  • Low premiums – As with standard group health coverage, there’s the option for your employees to cost-share the premiums.
  • Retiree benefits – Group Assured Access ensures your employees will qualify for health coverage at retirement, regardless of age or health status.
  • Fiscal advantage – Group Assured Access is a tax-effective way for employers to provide their employees with lifetime access to health benefits.

Benefits for your employees

  • Lifetime access to health benefits — They will always have the opportunity to enrol in a comprehensive and affordable health plan without medical underwriting.
  • No medical exclusions — There are no exclusions for existing or new medical conditions.
  • Access to a comprehensive personal health plan — Hospital and travel benefits are also available.
  • No waiting period
  • Portability – If a participant becomes covered under a group plan through another employer, he or she can convert to an individual Assured Access plan.

Plans for Small & Medium Business

A one-size-fits-all approach to benefit plan design limits your options.

Horizon 5-50 Plus from Medavie Blue Cross offers you more selection, flexibility, and value — whatever the size of your company.

Member Experience

At Medavie Blue Cross, we've had more than 75 years of experience perfecting our unique brand of health insurance. What that means for your members is they get more than just great health coverage: they also get access to our exclusive programs and perks aimed at providing innovative ways to focus on their health.