E M P L O Y E E

Benef i tnewsI N S I D E

The Script

3Partners in fraud

prevention

4The right price

5Reason to smile

6e Benefit News

7Legislative update

8

Aventis Healthcare Survey 2004Wouldn’t it be terrific if plan members rushed up to shake your hand, left gift baskets

on your desk or even quietly slipped notes into your mail slot thanking you for your

company benefits plan? In the real world, that doesn’t happen very often. But be

assured, plan members really do appreciate their plans and their employers.

Each year, the Aventis Healthcare Survey goes directly to plan members to get a sense of

how well sponsors, insurance companies and the healthcare system in general are

meeting their needs. This year marks the seventh annual survey and the results, plus the

commentary provided by the survey’s advisory board of industry experts, offer plenty of

substance for decision-makers to ponder.

QUARTERLY

Volume 11 • Issue 3

Third Quarter

2004

see Aventis Healthcare Survey on page 2

Measuring thevalue and

performance ofbenefits plans

6%58%

88% 12%

36%

Extremely well/very well

Somewhat well

Not very well/ not well at all

No Yes

Claim payment problems reported by plan members:

0

1%

1%

2%

Don’t know

Very positive

Does not influence opinion

Very negative

Somewhat negative

Neither positive or negative

Somewhat positive

• Denied coverage• Slow payment processes• Administrative issues• Denial of coverage for certain drugs

coverage provides peace of mind for

plan members. They feel secure

knowing they’ll be covered in the event

of a critical, possibly expensive, medical

situation.”

Needs not always metDespite the peace of mind that the plan

represents, survey scores indicate group

benefits plans aren’t always meeting

members’ needs as well as they once

did. Since 1999 the survey has recorded

a gradual decrease in the number of

participants reporting that their plans

meet their needs “extremely well” or

“very well.” This has been matched by

an increase in the number who say their

plans meet their needs only “somewhat

well.”

2

In the first six surveys respondents

consistently placed a high value on the

coverage provided by their group

benefits plans. This year, participants

were asked to rank the various

components of their plans in order of

importance. The scores indicate that

although some aspects of the plan rank

higher than others, all elements remain

relevant and important to plan

members. At the top of the list, the

drug plan received the highest rating

with a score of 98 percent, followed by

the dental plan (95%), extended

healthcare (95%), short/long-term

disability (94%), accidental death and

dismemberment (89%) and life

insurance rounded out the field with a

still-respectable 86 percent of plan

members ranking it either “very

important” or “somewhat important.”

These results, combined with the fact

that only 8 percent of respondents

“strongly agree” (and 19 percent

“somewhat agree”) that it is acceptable

for plan sponsors to decrease benefits

because of increasing plan costs,

indicate the high regard Canadians

have for their employer-sponsored plans

and their strong desire to preserve that

coverage.

You can’t tempt meTo further define the value plan

members place on their benefits plans,

for the second year in a row the Aventis

survey proposed a list of hypothetical

trade offs. This time, the carrots

dangled in front of plan members

included an extra week of vacation or

straight cash buy-outs escalating in

stages from $2,000 to $5,000 to

$8,000. Tempting? Not in the eyes of

plan members. Only 13 percent of

respondents opted for an extra week of

vacation in exchange for their benefits

plans, and just 11 percent said they

would choose the highest cash buy-out,

even though most aren’t likely to be

receiving $8,000 in services from their

plans each year. This unwillingness to

trade off benefits led the survey’s final

report to conclude, “Health benefits

Aventis Healthcare Survey continued from page 1

The merits of a goodeducationThe survey notes that plan members

who have encountered a problem

getting a claim paid in the past are less

likely to find that the plan is meeting

their needs. On the other hand, plan

members who feel they have a good

understanding of how their plans work

are more likely to give their plans higher

marks for meeting their needs, and are

less likely to experience any difficulties

relating to claims payments. Therefore,

plan sponsors and insurance companies

both have an opportunity to influence

satisfaction scores by stepping up plan

member education and communication

efforts. This shouldn’t only include

messages about what’s covered and how

to submit claims, but should address the

costs associated with providing the plan

and the importance of making informed

choices when using the coverage.

Name that insurancecompanyThe Aventis Healthcare Survey 2004

found that seven out of ten

participants could name the

insurance company that provided

their employer-sponsored benefits

plans. This high score surprised the

survey’s advisory board, but may

suggest that educational efforts are

working.

The degree to whichCanadians say their employer-sponsored benefits plansmeet their needs – 2004

To explain this measurable decline, the

survey’s advisory board points out that

the last few years haven’t seen plan

sponsors adding a lot in the way of

coverage. Advisory board member

Sarah Beech, a benefits practice leader

at Hewitt Associates, says, “Plan

maximums might not have been cut,

but they certainly haven’t increased

much either. Wigs for cancer patients

typically have a $200 limit, but decent

ones cost three or four times that much.

Plan coverage just hasn’t kept pace.”

6%58%

88% 12%

36%

Extremely well/very well

Somewhat well

Not very well/ not well at all

No Yes

Claim payment problems reported by plan members:

• Denied coverage• Slow payment processes• Administrative issues• Denial of coverage for certain drugs

6%58%

88% 12%

36%

Extremely well/very well

Somewhat well

Not very well/ not well at all

No Yes

Claim payment problems reported by plan members:

• Denied coverage• Slow payment processes• Administrative issues• Denial of coverage for certain drugs

Have you experienced problemsgetting a claim paid?

Be shameless about health promotionKeeping plan members satisfied is only part of the story. Plan sponsors also

need to be confident their investment is paying dividends in terms of reduced

absenteeism, greater productivity and increased job satisfaction among plan

members. Introducing health promotion and disease detection programs is a

strategy that has been successful for some organizations. These programs can

be designed to include aggregate reporting (with appropriate safeguards to

protect the privacy of the participant) that gives plan sponsors data to measure

and target specific risk factors in the employee population—an effective way

to influence benefits costs. Plan members agree, with 62 percent saying these

programs, often a collaborative effort involving employer, insurer and other

third party providers, are useful for keeping employees healthy and on-the-job.

When asked about workplace health promotion and education initiatives, two

out of every three respondents indicated a willingness to participate. Programs

that they perceive as being most beneficial to them (and therefore, most likely

to participate in) include detection programs for diabetes, hypertension and

osteoporosis (81%); on-site vaccination programs (73%) and weight-loss

programs (56%).

3

12%

ted by

0 10 20 30 40 50 60

29%

56%

3%

8%

1%

1%

2%

Don’t know

Very positive

Does not influence opinion

Very negative

Somewhat negative

Neither positive or negative

Somewhat positive

Denial of coverage for certain drugs

How benefits plans influence plan members’opinions of their employers

Canadian plan members place a high value on their employer-sponsored benefits

plans and are protective of the coverage provided, particularly in light of changes

being made to the services available through provincial health plans. That

fondness for the plan translates into goodwill for employers who sponsor and

pay for the benefits. Eighty-five percent of respondents indicate that their

benefits plans are a “very positive” or “somewhat positive” reflection on their

employers. So although that positive opinion isn’t often expressed with gifts and

cards, it’s far more likely to translate into increased efficiency and loyalty in the

office and on the production floor, where it counts the most.

You can access the complete text for all seven editions of the AventisHealthcare Survey at www.aventis-pharma.ca

Sources: Ipsos-Reid, The Aventis Healthcare Survey 2004

The Script2003 drug trends in the USAAlthough there are great differences between

the healthcare approaches followed in Canada

and the United States, there are also

opportunities for each country to learn from the

other’s experiences. Through Manulife

Financial’s relationship with ESI Canada and its

American counterpart, Express Scripts Inc.,

Canadian plan sponsors can gain insight into

trends taking place in the world’s largest

prescription drug market.

The year 2003 was significant for US healthcare.

One important development was the new

Medicare Prescription Drug Improvement and

Modernization Act, a law that promises to bring

relief to millions of Americans who have little or

no drug coverage. The Act is slated to become

effective in 2006. At the same time, a poor

economy and the resulting job losses meant

many plan members lost their employer-

sponsored prescription drug coverage. Also,

several widely prescribed drug products became

available over the counter leading to a decrease

in prescriptions filled in certain therapy classes.

Express Scripts’ 2003 Drug Trend Report

indicates drug costs in the United States rose

15.5 per cent in 2003. Part of the increase can

be attributed to higher costs per prescription, to

which inflation (+6.9%) and the use of more

expensive drugs (+3.2%) both contribute.

Changes in the utilization of common drugs also

contributed heavily to the increase in drug cost

(+6.8%), with people filling more prescriptions

in 2003. New drugs that came onto the market

during the year contributed only about 0.7

percent to the overall increase. This is offset by

increased generic drug use, which helped to

reduce drugs costs by 2.5 percent, and units per

prescription, which reduced costs by 0.1

percent.

It’s interesting to note that the top five therapy

classes were responsible for nearly 45 percent of

the growth in US drug spending in 2003. For

example, antihyperlipidemics (used to manage

cholesterol) accounted for nearly 14 per cent of

the growth alone. Also, direct consumer

advertising, which is permitted in the States but

not in Canada, is cited as a factor influencing

some drug trends South of the border.

Source: Express Scripts

Plan sponsors should be well-informed

about the measures their insurer is taking

to protect against fraud, misuse and

abuse of their group benefits plan.

Effective plan design, clear and concise

contract wording, pre-payment claims

review technology, experienced claims

payment staff, dedicated fraud prevention

teams and joint efforts through national

associations (like the Canadian Health

Care Anti-Fraud Association) are all

valuable industry strategies and efforts.

But many plan sponsors might also be

asking, “What can I do to help protect

the investment I’ve made in my

employees?”

Every plan sponsor understands the

challenge of rising healthcare costs and

the need to protect his or her benefits

plan from exploitation, whether the

inappropriate use originates with a plan

member, healthcare provider or some

other third party. By actively

communicating those challenges to plan

members, it’s possible to raise awareness

and influence the behaviours and

attitudes of those accessing the plan.

Encouraging ethical behaviour is a great

place to start, according to Jeff Alcock,

Manulife Financial’s Manager of

Investigative Services. Alcock points out,

“Most organizations already have

employee standards and codes of conduct

in place to protect company assets like

equipment, supplies and other property.

Why not include the benefits plan within

that code of conduct?” In this way, plan

members will begin to view the plan as a

tangible resource that needs to be

protected and used responsibly.

Taking a strong stance against healthcare

and benefits fraud, misuse and abuse is

easier when plan members understand

exactly what’s at risk. “How many plan

members know that benefits fraud results

in a potential financial loss for their

employer?” Alcock asks. “Many people

don’t realize that inappropriate use of the

plan hurts everyone in the company,

employer and employee alike. This could

be through a loss of company resources,

increased premiums or a decrease in

benefits coverage for plan members and

their families.”

Plan sponsors can set the tone for their

organization by supporting their insurer’s

efforts to verify that all services billed are

valid and all claims are adjudicated

according to the terms of the contract.

This verification often involves a claim

audit questionnaire that’s sent directly to

the plan member receiving the service.

The audit letter obtains additional

information about the claim and confirms

the plan member actually received the

services the health/dental provider has

billed for. Claim audits are conducted at

random, when insufficient information

has been provided on the claim form, or

when claims analysts have red flagged

the claim as being unusual.

Alcock says clear and regular

communication between plan sponsor

and plan member is the key to success.

"Plan members are the consumers of the

coverage provided by the plan, so they

play the leading role in protecting their

own benefits. Whether it's by making

sure their personal information – like

coordination of benefits information – is

up to date, carefully reviewing the

expenses incurred against their plan, or

reporting concerns to their plan

administrator or to Manulife directly, we

all win when everyone becomes a partner

in fraud prevention."

4

Partners in fraud prevention

An information sheet for plan

members titled Your

responsibilities when submitting a

health or dental claim is available

on our Web site. To access it

directly, go to http://groupbenefits.

manulife.com/Canada/GB_v2.nsf/

Public/ps_educational.

The right priceAfter a new drug has passed all of itspre-clinical and clinical trials andcompleted the drug review process toensure the product is safe, beneficial andeffective, the government regulator givesthe manufacturer the green light to beginmarketing the medicine.

Introductory pricing for brand name drugsin Canada is determined by a government-created regulatory body called thePatented Medicine Prices Review Board(PMPRB). The PMPRB was established in1987 with the mandate to ensure thatmanufacturers’ prices for patentedmedicines sold in Canada are notexcessive. To achieve that goal, the PMPRBconsiders the prices being charged for thedrug in other countries as well as the priceof comparable drugs (in the sametherapeutic class) when setting themaximum introductory price allowable.Subsequent increases to the manufacturer’sdrug prices are dictated by the ConsumerPrice Index. Manufacturers are alsorequired to report their price and salesinformation to the PMPRB.

The PMPRB sets the upper limit that canbe charged by brand name drugmanufacturers when selling theirproducts to drug wholesalers, hospitalsor pharmacists (if the manufacturer sellsdirect to pharmacists), but that’s only aportion of the cost that is ultimatelycharged to benefits plans.

Anatomy of a drug claimThe price of a prescription drug is made upof three components. These include

• Drug cost

• Pharmacy markup

• Regular dispensing fee or compounddispensing fee.

The drug cost is the amount the pharmacypays to purchase the drug from awholesaler and includes the wholesaler’smarkup. Pharmacy markup is theadditional charges a pharmacist may placeon a drug, above the drug cost. Themarkup is applied by the pharmacy to

cover the normal costs associated withoperating a business. The regulardispensing fee is the professional fee apharmacist charges to provide themedicine prescribed. When theprescription is for a medicine made up oftwo or more drugs mixed together, acompound dispensing fee is applied. Thisincludes both the professional fee plus anadditional amount in consideration for theextra time and materials used to preparethe compound medicine.

It pays to shop aroundIn theory, there’s no limit to the amount ofmoney a pharmacy can charge for markupor dispensing fee, although in practicethere are many good business reasons tokeep prices competitive. Still, it serveseveryone’s best interests when planmembers are encouraged to shop aroundand compare prices to make sure they’regetting the best value for their benefitsplan dollar.

Cost controlsProvincially funded drug plans that paydrug costs for eligible participants (such asseniors and citizens with low incomes) limitthe amount they will reimburse apharmacist for markup and dispensingfees. To help manage claims costs andpromote fairness for plan sponsors, planmembers and healthcare providers,privately sponsored plans with pay-directdrug cards can also apply limits to theamount that a pharmacy can charge, rightat the point of sale. This feature isn’tusually available with reimbursement drugplans because it’s impossible to re-negotiate the price with the pharmacistafter the sale has been made and thepaperwork has been submitted to theinsurance company.

Maximum markupFormulary drugs are drugs each provincialgovernment has decided to fund foreligible recipients. Each provincial drugplan determines the reasonable andcustomary price and maximum allowablemarkup for formulary drugs. Pay-direct

drug plans often use these same figureswhen calculating reimbursement for aformulary drug.

Non-formulary drugs are drugs not coveredby the provincial government for eligiblerecipients. In this case, insurancecompanies obtain the drug cost from anindependent drug wholesaler and establishthe maximum pharmacy markup bycomparing actual markup charges againstthe range of markup charges made byother providers in the same province.

Dispensing feemaximumsThe maximum allowable dispensing fee isdetermined by monitoring the dispensingfee limits paid by each provincial drugplan as well as through a periodic reviewof the average dispensing fees submittedfor each province. Plan sponsors can alsodesign their plans to include an upperlimit on the amount of reimbursementallowable for dispensing fee.

Both the maximum allowable markupsand maximum dispensing fees vary byprovince; therefore, insurers pay claimsbased on the province in which theprescription is filled. If the price chargedby the pharmacy exceeds the allowablemaximum, the claim payment is limitedto the amount allowed.

By understanding the great variety offactors influencing the final price of theprescriptions that plan members use, plansponsors are better equipped to makeimportant decisions about their benefitsplans. And by understanding the variouscost controls that can be built into theirplans, sponsors can better manage claimswhile continuing to provide coveragethat’s fair, reliable and easy for planmembers to use.

Many factors determine the costof brand name medicines

You can view the maximum pharmacymarkup and dispensing fees for plansthat use Manulife Financial’s ManuScriptpay-direct drug card by going towww.manulife.ca/groupbenefits/manuscriptlimits.html

5

Brushing up on dentalThere are a lot of gadgets and gizmosin the world designed to make our livesbetter and easier. But of all the modernconveniences, what’s the one thingmost people just can’t live without?

Please don’t take away my…When the Massachusetts Institute ofTechnology asked approximately 1,500adults and teens to choose from a list of“can’t live without it” items, the leadinganswer wasn’t any of the modernelectronic gadgets. Instead, it was a 15thcentury invention that currently retails forabout $2.49—the good ol’ reliabletoothbrush. Having figuratively brushedaside some pretty stiff competition, thehumble little toothbrush seems to haveearned its place as one of history’s greatestinventions. And people’s obvious concernfor their teeth explains why dentalcoverage is one of the most popularcomponents of group benefits plans.

In benefits plan surveys plan membersranked their preference for the dentalplan second to only their drug plans.This is all good news for the dentalprofession (and anyone involved in thetoothbrush business). But, the findingsare equally encouraging for plansponsors because clearly, plan membersunderstand the importance that goodoral hygiene, combined withprofessional dental care, plays in theiroverall health and well-being.

In recent years, much press and attentionhas been given to the pharmaceutical

industry where powerful new drugs havebrought new treatment options to planmembers and new cost concerns to plansponsors. Although some equallyexciting developments have taken placein the dental industry, the impact oncosts has been considerably less. As aLIMRA International (an insuranceindustry research and marketingorganization) report on the subjectstates, “Dental insurance is characterizedby a high volume of low cost claims suchas routine dental exams. Catastrophicclaims are rare; it is unlikely that asubscriber will need multiplesimultaneous root canals. Low benefitmaximums also keep high claims undercontrol.”

Your mouth says a lotabout your healthThrough regular visits, dentists ensureplan members’ teeth and gums remainhealthy by inspecting for cavities,identifying dental problems early andpreventing those problems from gettingworse. Check ups are also valuable forthe early detection of some much moreinsidious health conditions.

Often, dentists are the first to spot thesmall red or white lesions on the lips orinside the mouth that are associatedwith oral cancer. Although it’s rarecompared to other forms of thedisease, oral cancer has a high mortalityrate so early detection is important.Age, smoking, alcohol consumption(particularly when combined withsmoking) and excessive exposure to thesun are among the risk factors for oralcancer.

There’s evidence suggesting that babiescan inherit the germs that cause toothdecay from their mothers duringpregnancy, leading to dental problemsby the time they become toddlers.Research also indicates that oral diseasein mothers is linked to babies beingborn pre-term and with lower birthweights, making good dental habitsand care doubly important for womenwho are pregnant or who plan to starta family.

More people arekeeping more teethOver the years, dental plans have helpedmake education and access to dental

care easier, so today many people keeptheir teeth healthy and intact for theirentire lives. This means that in a countrylike Canada where the population isaging, more plan members will needtreatments to address specific age-relateddental conditions such as tooth wear, drymouth, bone and gum recession andperiodontal disease. According to theOntario Dental Association, at least 80percent of the adult population suffersfrom some form of periodontal disease (adisease caused by plaque build up on thegums), although most aren’t aware oftheir condition. Without treatment, thedisease progresses to gingivitis and thenperiodontitis. At this stage the gums canbe weakened to the point where they areunable to support teeth.

Putting their moneywhere their mouths areFor many plan members, a bright whitesmile and perfectly aligned teeth is adream that’s within reach. Dentalprocedures like tooth straightening,whitening and veneers are widelyavailable. And because most plans havecost controls that either limit or excludeclaims for purely cosmetic treatments,many plan members appear to be willingto pay from their own pockets to achievethat award-winning smile.

Other advancements in dental care andmaterials offer advantages to both planmembers and plan sponsors. Only a fewyears ago, most plans offered coverage fordental bridges and crowns, but not forimplants (a procedure in which a porcelainreplacement tooth is attached to the bonebeneath the patient's gum by a titaniumscrew). Today, implants are often thepreferred treatment option. Thanks toimprovements in the materials used tomanufacture the implants, they now lastlonger, involve a less invasive procedure forthe patient and cost less in the long-term.

The best invention sincethe toothbrushAccording to researchers in England, wemay only be a few years away fromgrowing our own replacement teeth.The technique uses stem cells to allow apatient to grow a new tooth in the spotwhere one is missing and might makefalse teeth a thing of the past.

6

Which invention can yousimply not live without?

Item Adults Teens

Toothbrush 42% 34%

Car 37% 31%

Personalcomputer

6% 16%

Cellularphone

6% 10%

Microwaveoven

6% 7%

Source: Lemelson-MIT 2003 Invention Index ™

Reason to smile

7

Reading between the teethWhen an angry dog bares a set of razor sharp canines, it provokes aninstinctive response in people. In the same way, when someoneflashes a warm, welcoming smile, he or she is sending an equallypowerful message. Well cared for teeth can influence everythingfrom overall health to social interaction, nutrition, speech and self-esteem.

The idea that people are afraid of their dentists seems to be an oldcliché. According to a survey conducted by the Ontario DentalAssociation, plan members like their dentists well enough to formlong-term relationships with them. The study found that 89 percentof plan members have had the same dentist for three years or more.Well established, trusting dentist-patient relationships provideconsistency of care to plan members and work best when there’splenty of communication between dental care provider, plan memberand plan administrator.

Questions plan members should ask theirdentist• Can you describe what you’re doing during my examination?

• Can you explain the treatment alternatives and which one will bebest for me?

• Can you explain the costs before treatment takes place?

• Can a pre-determination of coverage be completed and submittedto my insurance provider before treatment takes place?

• What treatment is required immediately? Can any treatments bedelayed until later?

• Can I have a copy of the bill sent to my insurance company?

Questions plan members should ask theirplan administrator• What services does my dental plan include and exclude?

• Can you explain what cost-sharing the plan includes and how itworks?

• Are there any dollar limits or frequency of treatment limits built intomy plan?

• At what intervals does my plan provide coverage for regular checkups and cleanings?

People generally perceive dental services to be expensive, so yourdental plan is a valuable tool in the effort to attract the bestcandidates to your organization and keep them happy and healthyemployees over the long-term. Although each individual has his orher own predisposition to cavities and other dental conditions, theimportance that plan members attach to their dental healthindicates they are active, willing and conscientious participants inprevention. And that’s something to smile about.

eBenefit NewsTechnological leap frogWell before the first personal computers found their way into

offices and homes, many people dreamed of the day when

information and communications technology would make

paper forms and filing cabinets obsolete. But twenty-five

years later, we’re still dealing with a surprising volume of

paper and manual transactions.

For many reasons, including personal preference and the cost

of purchasing technology and keeping it current, the

electronic transaction hasn’t taken over exactly the way some

people imagined. One contributing factor might be the

technology gap that exists between the country’s smallest

(under 20 employees) and largest (100 employees and over)

enterprises.

According to Statistics Canada, large companies adopted

basic technology such as personal computer workstations and

the Internet much quicker than their smaller counterparts

who only achieved equality in these areas as recently as 2002.

And now that this basic technology is fundamental to

business, larger firms have jumped ahead again by embracing

new technologies such as high-speed Internet, intranet and

extranet sites and electronic data interchange. Using figures

from 2002, Statistics Canada reports only 27 percent of small

businesses have a Web site whereas more than three-quarters

of all large Canadian firms have one.

The world of Group Benefits is an example of one industry

where technology is in place for customers to enjoy virtually

paperless transactions. Using secure Web sites, insurers can

offer plan members the convenience of services like direct

deposit for claims payments, electronic claims statements and

e-mail notification when a claim has been processed.

However, even in this example, some people have been slow

to take full advantage of the paperless claims experience.

The next waveWhile paper may never completely disappear from your life,

future generations will undoubtedly have less of it to shuffle.

In the Aventis Healthcare Survey 2004, 76 percent of

employees 18 to 34 years of age expressed a desire to receive

benefits information via the Internet (compared to 50 percent

of plan members age 55 and over). And a new study by

Statistics Canada shows virtually every school in Canada has

computers for students with 9 out of 10 of the machines

connected to the Internet. While schools aren’t in any way

immune to the same fiscal challenges faced by business,

these students (and those who follow) will be well acquainted

with all that information and communications technology has

to offer them.

Sources: Statistics Canada, The Daily, catalogue 11-001-XIE, (February23, 2004 and June 10, 2004); Aventis Healthcare Survey 2004.

Dental Associations

Dental associations are a great source of information ontreatment and prevention. The Canadian Dental AssociationWeb site is a good place to start (http://www.cda-adc.ca).Click on “Links” to find your provincial dental organizationsand associations.

In December 2003, the government of Ontario introduced Bill 31—The HealthInformation Protection Act, 2003. The Act establishes laws to be followed byOntario’s Health Information Custodians when collecting, using, storing anddisclosing personally identifying health information. Healthcare practitioners, long-term care facilities, hospitals, ambulance services, pharmacies, medical labs and socialworkers are all considered to be custodians of health information in Ontario.

The Act limits the type of health information that can be collected, used anddisclosed and gives Ontarians the right of access to their own information and themeans to have incomplete or inaccurate information corrected. The legislation alsoincludes a “lock-box” provision allowing individuals to say when their personalhealth information cannot be shared between Health Information Custodians.

Bill 31 also includes rules to be followed by non-health organizations (such asinsurance companies and employers) that receive personal health information fromHealth Information Custodians. Patients must provide express consent before theirpersonal health information can be shared in this manner.

The provincial Information and Privacy Commissioner will be responsible forreviewing policies, investigating complaints and ensuring compliance with thelegislation. The Bill sets out fines for individuals ($50,000) and organizations($250,000), and when someone is convicted of an offence under the Act, the personaffected will have the right to sue for damages.

The Health Information Protection Act, 2003 passed third reading on May 17, 2004and will come into effect on November 1, 2004.

Ontario budgetThe following changes were announced in Ontario’s spring budget.

Eye exams: Effective November 1, 2004, the provincial health plan will no longer

cover the cost of routine eye exams. The only exception is for seniors age 65 and

over and those under the age of 20 years.

Chiropractic: Effective fall 2004, the province will no longer pay for chiropractic

services.

Physiotherapy: Beginning in the fall of 2004, the province will no longer cover the

cost of physiotherapy services. The only exception is that seniors will continue to

receive physiotherapy through home care and long-term care facilities.

Vaccines: The vaccines for chicken pox, meningitis and pneumonia will be added to

the province’s children’s immunization program.

Please Note:

Employee Benefit News is published to

provide information about current issues and

assist in the decision-making process. Our

articles however, are not intended to provide

medical, financial or legal advice and any

queries you may have should be directed to an

appropriate professional advisor.

For further benefit information,

please call your usual Manulife

Financial contacts.

Employee Benefit News is

published by:

Manulife Financial

Group Benefits

380 Weber Street North

Waterloo, Ontario N2J 4V7

Please send your comments and

suggestions to the EBN editor,

by fax: (519) 883-0406, or use the

“contact editor” feature on our Web

site.

Extra! Extra?

Plan sponsors and advisors can

download additional copies of this

Employee Benefit News or previous

issues from the “Newsletters” page on

Manulife Financial’s Web site at

www.manulife.ca/groupbenefits.

Additional copies of this or previous

issues are also available in hardcopy.

Fax requests to (800) 230-2520.

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Legislative updateHealth Information Protection Act comes intoeffect November 1