Benchmarking Terms (Glossary)

Extended Health Care Coverage and Drug

Closed Drug: refers to any restriction such as mandatory or voluntary generic substitution or low cost alternative on a prescription drug plan.

EI Reduction: is a yes/no field in STD which allows users to record whether the group has applied for the EI Premium Reduction. Some STD programs are eligible for this benefit: https://www.canada.ca/en/employment-social-development/programs/ei/ei-list/ei-employers/premium-reduction-program.html

Generic: refers to either a voluntary or mandatory generic substitution drug definition on a prescription drug plan.

LCA: refers to a Lower Cost Alternative drug definition on a prescription drug plan.

Managed Formulary: refers to any actively managed drug formulary.  In other words, any definitions of drugs to be included or excluded from coverage based on a set of criteria. 

• Can be managed by a provider pharmacy team, a provincial health authority or a third party  
• Commonly based on principles beyond what drugs Health Canada may have approved but also consideration given to the cost of the medication and it's proven therapeutic value for a given condition

Tiered Formulary: to the different levels of coverage, coinsurance, deductibles, and drug definitions that may apply to a plan member. Used to provide an incentive for plan members to use a preferred pharmacy solution or ask their physician to try and prescribe within a certain formulary such as provincial coverage or a provider offering. 

• Example 1 - 80% Mandatory Generic & 100% Provincial Formulary
• Example 2 - 70% Voluntary Generic & 90% Preferred Pharmacy

Overall Maximum: all eligible practitioners on the plan are included under one maximum amount for the benefit period or year.

• Example - $1000 Overall Maximum for All Practitioners

Paramedical Combined Maximum: two or more practitioners are grouped together under the same annual or benefit period maximum amount.

• Example - $500 for Physiotherapy and Occupational Therapy, and/or $500 for Psychologist, Clinical Counsellor and Master of Social Work.

A Benefits Plan will typically have one overall maximum, but may have multiple combined maximums consisting of different groups of often similar or related practitioners. It is possible to have an Overall Maximum and Combined Maximums per practitioner.

Primary Industry: The industry is determined by the entry on the group page for Primary Industry. Primary Industry codes closely follow the North American Industry Classification System (NAIC) codes. In CloudAdvisors benchmarking users can select a custom comparison group by industry, region and group size. For a more complete understanding of these industries please refer to Industry Canada below:

http://www23.statcan.gc.ca/imdb/p3VD.pl?Function=getVD&TVD=380372