For an SME, every dollar counts. Offering attractive group benefits to your employees may seem out of reach due to factors such as high costs, complex procedures or a lack of negotiating power. However, in a competitive job market, not having a group insurance plan can hamper your growth and make it more difficult to retain employees. AGA’s ELITE 5-49 program was specifically designed to address this reality. Since 2017, it has enabled hundreds of businesses with 5 to 49 employees to pool their strengths and share the risk while offering an innovative, competitive plan.

Édith Pelletier, Consulting Director at AGA, is particularly enthusiastic about ELITE 5-49: “When I meet SME representatives and mention that I work in group benefits, they often tell me that they’d like to offer something to their employees, but it’s too expensive or too complicated. However, as soon as I tell them about ELITE 5-49, they see that there are solutions within their reach,” she said.

We asked Édith to tell us more about ELITE 5-49, which is drawing an increasing number of businesses.

What sets ELITE 5-49 apart from other group insurance plans?

E.P.: ELITE 5-49 is an easy way for businesses with 5 to 49 employees to pool their resources and benefit from coverage that’s comparable to that of larger organizations, without the complexity or high costs. By pooling their experience with insurers, SMEs share the risk, which stabilizes costs over the long term.

The plan is managed through our AGA +PLUS service, which provides a convenient platform for administrators and facilitates their work. Plan members deal directly with AGA for claim submissions and questions about their plan, minimizing the involvement of SMEs’ plan administrators.

What does ELITE 5-49 offer in concrete terms?

E.P.: Each business takes out basic coverage according to the usual parameters of a group insurance plan. AGA’s experts have designed a plan that meets the majority of needs and is regularly re-assessed to ensure that it’s in line with market trends. The growing number of businesses that have joined the pool in the last eight years is a good indicator of how competitive our offering is. The plan covers all of the traditional components: health care, prescription drugs, dental care, disability, life insurance and accidental death and dismemberment insurance.

So everyone has the same plan?

E.P.: Not necessarily. Each group can customize its plan with additional types of coverage, such as an employee assistance program or telehealth, at tailored rates. It’s a balance of simplicity and flexibility. We offer a solid foundation, but each employer can enhance it according to their needs and those of their employees.

The big question: is cost stability ensured within ELITE 5-49?

E.P.: Cost stability is, of course, central to the design of ELITE 5-49. It all comes down to the 3 Ps: preselection, power and practices.

• Preselection: As I say to clients, there’s a reason that ELITE is part of the program’s name! The groups are carefully selected according to strict eligibility criteria. It’s important to point out that all members are jointly and severally responsible for the results of their experience and for the development of the products and services offered in the pool.
  
  
• Power: With an ever-growing pool of tens of thousands plan members, we have negotiating power that each employer wouldn’t have on their own. Having such a high number of plan members enables us to achieve greater cost predictability and gives us a stronger voice with insurers.
  
  
• Practices: We then apply strict cost management practices, which all the groups must adhere to, to keep cost increases to a minimum. For example, we offer automatic generic substitution for drugs and stepwise drug therapy. Independent pharmacogenetic testing is also offered free of charge for disability cases, on a voluntary basis, to more accurately identify the best treatments to consider and promote a quick recovery. In addition, we provide employers with messages to raise awareness regarding responsible drug purchases among their employees. It’s a 360-degree approach to promote the plan’s stability and sustainability.

With a plan like ELITE 5-49, what kind of service can employees expect?

E.P.: One of ELITE 5-49’s strong points is that plan members have access to support that rivals that offered by bigger plans. They benefit from a pay direct card, which allows for online claim submission and automatic claim payments at pharmacies, dentists and other health care professionals enrolled in TELUS Health’s online payment service. Other claims can be processed via a user-friendly portal where members can also view the details of their coverage. And if they need further assistance, AGA’s call centre is at their disposal.

The ELITE 5-49 webpage on AGA’s website contains details about the pool, including information about the program’s unique features. These include access to AGA’s Exclusive Benefits for Members program and a special discount on FlightClaim’s Peace of Mind coverage. There’s no shortage of reasons for SMEs to join ELITE 5-49!