Canadian HR Reporter

CANADIAN HR REPORTER CANADIAN HR REPORTER April 21, 2014 April 21, 2014 NEWS NEWS 9 For example, some immigrants are uncomfortable with how work teams tend to operate in Canada, with managers often encouraging individual contribution. "Culturally, many IEPs expect to be told what to do and not question the direction provided," said Draper. "Generally, they can feel that our open methods are weak and unproductive whereas the workplace culture they are familiar with is much stronger and productive. is viewpoint will lead to some tension in the workplace." While immigrants need to learn about Canada's workplace culture, employers are also re- sponsible for helping ease the transition, said Draper. "When a Canadian employer makes little or no eff ort to assist an IEP with their integration into their organization, there will be confl ict. An IEP may be consid- ered less of an employee than their Canadian counterpart because they think diff erently and perform their role diff erently. is will neg- atively impact career growth and may lead to unemployment." Draper has devoted a lot of his time to mentoring IEPs to em- ployment and then working with them to help them appreciate the culture of their new employer. "I have come to clearly under- stand the diffi culties that highly skilled IEPs face when seeking skills or education-related em- ployment. I have also come to learn how a simple off hand re- mark by a Canadian-educated peer can create fear and discom- fort. As a mentor, I have worked with numerous mentees to help them understand that while they took the remark seriously, their peer did not mean anything by it." At her 20-year-old organiza- tion GEM Healthcare Services, Gaye Moffett has hired many immigrants. Back in 1994, about one-half of the employees were foreign-born — now, it's about 85 per cent, said Moff ett, founder and CEO at the private health- care service provider, which has 150 employees. The immigrants range from companions and personal support workers to registered nurses and registered practical nurses. Some come through the Ontario Works program, having come to Canada and been unable to fi nd work, and GEM retrains them, said Moff ett, who was also recognized for her contributions by HIO. GEM has always been very welcoming and open to foreign- trained professionals, said Mof- fett, and everyone is treated the same. If needed, people are sent off for further language testing and training, though fewer people need to go these days because of Canada's stricter immigration rules, she said. Most of the people come from central Africa whereas before the Caribbean was more popular, said Moff ett, who has been a big sup- porter of HIO's cause. " ere's a business case — you want employees, you want good employees, you bring them on and they'll be very loyal to you." Other winners e others recognized were: •Hicham Adra, president of Fitz- roy Enterprises •Emma Creese, manager, HR re- gional support, at Scotiabank •George Chin, manager, business planning and support, Ministry of the Attorney General, east region. Services and Policy Research at the University of British Columbia in Vancouver. "In particular, what we saw over the last 20 years was that the spread between premiums col- lected and benefi ts paid out has really widened — in particular for the small group market or the in- sured plan market," said Law, who was the lead author of the analysis paper. "When you look at the paper, you don't actually see a big change in the self-insured market… But for small business and individuals, there's pretty massive increases in the percentage of premiums that aren't paid out as benefi ts. So what that suggests to us is small em- ployers are not being well-served by this." In 1991, private insurers paid out 92 per cent of plan premiums as benefi ts. In 2011, they paid out 74 per cent. But Canadians with individual plans had just 38 per cent of their premiums paid out as benefi ts. It certainly appears that small businesses and individuals are getting the raw end of the deal, said Lewis. "In the case of large companies, they will be more disciplined in their relationship with the insur- ers and they will have more capac- ity to monitor what the ratio of payouts is to premiums collected. And they're in a stronger bargain- ing position," he said. "If you're an individual, you're just buying an insurance policy and you're at the mercy of that marketplace — the people selling the insurance and managing those claims have all the information, and you don't have any." Intuitively, it makes sense that the gap is wider for small to medium-sized businesses, said Johnny Ma, president and COO of Mapol, a consulting fi rm that specializes in private drug plans based in Mississauga, Ont. "(It) kind of makes sense from an insurance perspective as well, because when you're small to medium-sized, you're in a bigger pooled group and there's prob- ably more risk… insurers kind of have to hedge for that and collect more." Where is the money going? So, where have those billions of dollars in premiums been going? e short answer is we don't ex- actly know, said Law. "We don't know if that's going to administration, we don't know if it's going to profi ts, we don't know if it's going to acquisitions by the company or something else. So, given these health-care dollars, I think it's important that we have better information on where that's going." In the paper, Law and his co- authors considered four potential explanations: that the cost of ad- ministering plans increased, man- agement practices reduced the cost of the services provided, in- surance fi rms are increasing their reserve funds or private insurers increased the markups charged on coverage plans. But the authors weren't able to access all the data they'd asked for — and the body of publicly avail- able information on private health insurance is relatively scant, said Lewis. "In the case of the for-profi t sector, the disclosures are pretty minimal. And, of course, in a sense, they're trade secrets," he said. "If you're a private insurer and you want to succeed in a competi- tive marketplace, opening up your books entirely — either in terms of what you're paying various pro- viders and the prices that you're able to negotiate or the way you manage your benefi ts plans — is a trade secret." In his paper, Law called for greater transparency and disclosure. "I would hope that we can get more transparency from private insurers in terms of where this money's actually going because there's not a lot of data out there that talks about benefi ts costs and what's happening with these pre- miums," he said. But Ma is unsure whether greater transparency is realisti- cally going to occur. "I'm not sure if it's ever going to happen — that really happens at the individual plan sponsor level, and right now they're looking at the industry level," he said. " ere's so many players in the market from an insurer's per- spective — how can you stan- dardize that without making it anti-competitive?" Is more regulation needed in Canada? As part of the Aff ordable Care Act in the United States, the Obama administration set caps — or, more accurately, fl oors — on the percentage of premiums that have to be paid back to plan members as benefi ts, said Law. "In the U.S., the numbers are 80 per cent for small group plans and 85 per cent for large group plans. So if a large group plan insurer takes in a dollar in premiums, they have to pay at least 85 cents back to their plan members as benefi ts," he said, adding that US$1.1 billion was paid back to plan members in rebates in 2012. "What governments could do, along with encouraging greater transparency, would be to con- sider imposing the same sort of percentage fl oors that the United States has put into play. I think it's a pretty good model for ensuring that people get good value from these plans." But, at this point, Canada is nowhere near implementing per- centage fl oors like in the U.S., said Ma. "In the U.S., under the new leg- islation, (the private industry) is more regulated… we need to get there fi rst before we can even talk about whether any type of mini- mum payout is required. I person- ally don't think it's going to hap- pen," he said. "But then Canada has always been about 10 years behind the U.S. in terms of health-care policy, especially on the private side plan designs." As things currently stand, Can- ada tends to regulate third-party insurance very lightly compared to many other countries, said Lewis — and right now, there are no rules around the proportions of premiums insurers must pay out. "In Canada, compared to other countries, especially the Europe- an countries, it's much more of a hands-off approach. And I think one of the consequences is insur- ers are freer to vary in how they approach both negotiations with suppliers of services and their ad- judication of claims," he said. But greater regulation may be a good move, said Lewis. "If we're going to have a lot of third-party insurance, I think it makes perfect sense to call for greater regulation — no greater than in any other country that has these arrangements, but sort of catching up to them in terms of oversight of these practices." 'Scant' body of publicly available information 'Scant' body of publicly available information BENEFITS < pg. 1 Easing transition Easing transition AWARDS < pg. 8 Canada regulates third-party insurance lightly compared to other countries and there are no rules around the proportion of premiums insurers must pay out.

• Cover