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Benefits Plan changes coming
September 1, 2025
New for September 1, 2025
Each year, the Trustees review the Plan’s financial position and make decisions that will best position the Plan for the future. This year’s benefit changes, taking effect September 1, 2025, are:
Anti-obesity drugs
- Introducing a maximum amount of coverage per 12 months for anti-obesity drugs – $2,000 per person. Eligible claims are reimbursed at 100% (with an $8 dispensing fee limit) until $2,000 has been paid from the Plan.
For example, if you are approved for coverage for an anti-obesity medication through the Prior Authorization process on November 1, 2025, a maximum of $2,000 will apply toward anti-obesity drug claims during a 12-month benefit period — from November 1, 2025, to October 31, 2026. This means that any eligible claims for anti-obesity medications submitted during this timeframe will be reimbursed up to a total of $2,000. Once this maximum is reached, no further reimbursement will be provided for these drugs until a new 12-month benefit period begins.
Examples of anti-obesity drugs include: Wegovy, Saxenda, Contrave, and Xenica.
Note: Members using certain GLP-1 medications (e.g., Ozempic) to treat Diabetes will not be subject to this $2,000 maximum. - Introducing prior authorization (i.e., a formal approval process) for Plan Members who previously did not have to go through this process.
Specifically, it applies to:- Ozempic® or Rybelsus® when used for non-diabetes (off-label*) purposes
- Saxenda®, Contrave®, and Xenical®
If you are using any of these medications for weight management and have not
previously gone through prior authorization, you will now be required to complete
this process before your plan will continue to cover the cost.
Note: affected Plan Members will receive a separate communication from
Canada Life this summer. It will describe the steps needed to apply for coverage, and
Members will have up to October 31, 2025 to complete the application.
You’ll receive a letter if you’ve been taking an anti-obesity medication before it
required prior authorization. Specifically, if: you started off-label Ozempic® or
Rybelsus® for obesity before September 20, 2023, and continue to receive this
medication OR you started Saxenda®, Contrave®, or Xenical® before January 1, 2025,
and continue to receive this medication. This letter will explain the next steps
required to continue coverage under the new process.
* Off-label means the medication is being used for a purpose not officially approved
by Health Canada, such as using Ozempic® or Rybelsus® for weight loss rather
than diabetes.
Paramedical services
- Reducing coverage for all paramedical practitioners from 100% to 90%. This means you’ll pay 10% of the cost for services like physiotherapy, massage therapy, and chiropractic care.
- The same maximum coverage continues to apply each Plan Year, which is:
Up to $550 per person, for each type of practitioner: Acupuncturist, Chiropodist/Podiatrist, Chiropractor, Dietitian, Naturopath, Osteopath, Registered Massage Therapist, and Speech Therapist/Speech Language Pathologist/Audiologist.
Up to $3,000 per person for combined services from a Psychologist, Social Worker, Registered Family Therapist, and Psychotherapist.
Up to $1,500 per person for combined services from a Physiotherapist, Athletic Therapist, and Occupational Therapist.
Health Care Spending Account (HCSA)
- Reducing the annual Health Care Spending Account (HCSA) deposit from
$850 to $500. - This amount will go into your account on September 1, 2025, and you will have two Plan Years to spend it on eligible Health and Dental Expenses.
Reminder! Check your HCSA balance on the Canada Life website.
Your deposit from September 1, 2024 ($850) will roll over to the next Plan Year if you haven’t already used it. If you have a leftover amount from…
Your 2023 deposit – it must be used by August 31, 2025
Your 2024 deposit – it must be used by August 31, 2026
Here’s a helpful list of products and services you can claim through your HCSA:
What’s driving the changes?
The reality is – claim costs are rising faster than funding increases.
Following a global pandemic that no one could have predicted, we’re seeing new trends emerging, potentially forever changing people’s needs and the way they use benefits.
More Plan Members and their families are using their benefits, and each claim costs more than it did before. At the same time, the government funding that pays for these benefits has seen only a slight increase. As you can imagine, when costs go up faster than funding increases, the Plan can quickly become imbalanced, and that can put the Plan’s future at risk.
Here’s a snapshot of claim costs over the past three years, where we’re seeing an increase in every category. Between 2022 and 2024, the Compound Annual Growth Rate was 14%.
|
Drugs
|
Dental
|
Paramedical
|
Vision
|
Other health
|
|
|---|---|---|---|---|---|
| 2024 | $14,576,804 | $16,461,329 | $10,683,171 | $3,216,266 | $2,085,674 |
| 2023 | $12,593,110 | $14,864,409 | $9,008,548 | $3,144,784 | $1,778,483 |
| 2022 | $11,086,635 | $13,324,489 | $7,406,399 | $2,770,250 | $1,573,595 |
We’re not alone in facing these challenges. Across our sector, other benefit plans are seeing the same trend: rising claim volumes and higher claim costs, which are putting pressure on limited funding. As a result, many plans – like ours – are being forced to make tough decisions now, including reducing benefits.
As Trustees, we have a responsibility to protect the Plan, not just for today, but going forward. If funding levels don’t increase sufficiently, we may be faced with making these kinds of difficult decisions again next year and in the years after that.
What are we doing to help?
We understand that the impact of these changes, as well as understanding and keeping track of them, can be frustrating. We are emphasizing clear and timely communication. The Trustees have also implemented operational efficiencies, reducing Plan administrative expenses from 4.2% of total costs in 2022 to 3.6% in 2024. However, because the Plan’s administrative costs are only 3.6% of total costs, these measures aren’t enough to address the funding shortfall caused by rising claim costs.
What can you do to help?
Group benefits are built on the idea of working and benefiting together. Review these simple tips on how to make the most of your benefits while also helping to protect the Plan for everyone.
Answering your questions
To help you better understand what’s happening, we’ve included a few frequently asked questions below. We’re also planning to host Town Halls this fall, where you’ll have a chance to hear directly from the Plan’s Trustees, ask questions, and share what’s on your mind.
Frequently asked questions
Q1. How is ONE-T funded?
A1. It can be helpful to think of ONE-T like a bank account. Funding comes into “the account” from the Crown and is then used to operate and deliver benefits under the Plan. All Crown funding is the result of a grant, which is currently approximately $6,300 per Full-Time Equivalent Position (FTE).
Q2. Does ONE-T have any say in how much “per FTE” funding we receive?
A2. No. The Trustees must work with the funding that is provided and are not involved in funding discussions. ONE-T is independent from CAEAS-ECAB and the Crown and can’t advocate on behalf of any party.
Q3. Does CAEAS-ECAB get a say on plan design changes? What about Plan Members?
A3. ONE-T meets with CAEAS-ECAB each spring to discuss plan design – this year, we met on four occasions, given the changes that are required. ONE-T Trustees value and consider the input from all interested parties; however, it is ultimately the Trustees who bear the responsibility of making the difficult choices around plan design.
In the past, ONE-T has surveyed Plan Members about needs and priorities, and we’re planning another survey in 2026. Data from surveys is helpful, but not always a direct driver of plan design changes. While we strive to address Plan Members’ needs, we must make plan design decisions that best spread out the impact across all Plan Members and protect our most vulnerable Plan Members, too.
For any other questions regarding these Benefit Plan changes, please contact info@one-t.ca
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