Understanding Your Group Benefits at Work 2025

Updated: March 2025 · bremo.io

Your employer group benefits plan is one of the most valuable parts of your compensation package — yet many Canadians don't fully understand what they have or how to use it. A comprehensive group benefits package can be worth $5,000–$15,000+ per year in value, covering health, dental, vision, disability, life insurance, and more.

Components of a Typical Group Benefits Plan

Extended Health Benefits (EHB)

The core health benefit that covers expenses not covered by your provincial plan:

• Prescription drugs (usually 80% after deductible, or 100% for generics)
• Paramedical services (physiotherapy, chiropractic, massage, psychology, etc.)
• Medical equipment (orthotics, hearing aids, CPAP, crutches)
• Private/semi-private hospital room upgrade
• Emergency out-of-province/out-of-country medical (very important)
• Ambulance services

Dental Benefits

Dental coverage is broken into tiers — each with its own coverage percentage:

• Basic/Preventive (cleanings, X-rays): usually 80–100%
• Restorative (fillings, extractions, root canals): usually 70–80%
• Major (crowns, bridges, dentures): usually 50%
• Orthodontics: usually 50% up to a lifetime maximum
• Annual maximum: most plans $1,000–$2,500/person

Short-Term Disability (STD)

Pays a percentage of your salary (typically 55–80%) if you're unable to work due to illness or injury for a short period. Usually kicks in after a waiting period (sick days or 1–2 weeks) and pays for up to 17–52 weeks.

Long-Term Disability (LTD)

Picks up after STD ends. Typically covers 60–66.7% of your pre-disability income. Most plans switch from "own occupation" to "any occupation" definition after 24 months. Benefits continue to age 65 in most plans.

Life Insurance

Most group plans include a base life insurance benefit (often 1–2x annual salary) plus optional additional coverage. Accidental death and dismemberment (AD&D) insurance is often included or available as an add-on. Group life typically requires no medical underwriting up to the non-evidence maximum.

Employee and Family Assistance Program (EFAP)

Free, confidential counselling and support services for employees and their families. Typically includes short-term mental health counselling (6–12 sessions), financial counselling, legal advice, and work-life support. One of the most underused benefits in most plans.

Optional/Voluntary Benefits

Many plans allow employees to purchase optional additional coverage:

• Additional life insurance (above the base amount)
• Critical illness insurance
• Dependent life insurance
• Health care spending account top-up
• Vision care enhancement

How to Read Your Benefits Booklet

Your benefits booklet (or plan guide) is the definitive document for understanding your coverage. Key sections to review:

1. Summary of benefits: High-level overview of all covered services
2. Annual maximums: Per-person and family limits for each benefit type
3. Deductibles and co-payments: What you pay before coverage kicks in
4. Eligible providers: Who must provide the service for it to be covered
5. Claim submission deadlines: How long you have to submit a claim
6. Coordination of benefits: Rules if you and your spouse both have coverage

Coordination of Benefits (COB)

If both you and your spouse have group benefits through your respective employers, you can coordinate benefits to potentially cover 100% of eligible expenses:

• Your own plan is "primary" for your expenses
• Your spouse's plan is "secondary" and can cover some or all of the remainder
• Children are covered under the plan of the parent whose birthday falls first in the year (birthday rule)

Flexible Benefits / Flex Plans

Some employers offer flexible benefits (flex plans or cafeteria plans) where employees allocate benefit credits among different coverage options. You might direct more credits toward dental if you have significant dental needs and less toward life insurance if you're single with no dependents. Flex plans also often include health care spending accounts (HCSAs).

What Happens to Benefits When You Leave a Job

Maximizing Your Group Benefits

1. Know your annual maximums and plan service use accordingly
2. Submit every eligible expense — drugs, physio, glasses, dental, massage
3. Use your EFAP for free counselling, legal, and financial advice
4. Review optional coverage at each annual enrollment period
5. Coordinate with your spouse's plan for maximum reimbursement
6. Don't miss claim deadlines — most plans require claims within 12 months of service