A primer on plan design and funding

Principals/Vice-Principals (P/VP)

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A primer on plan design and funding

The past few years have been challenging for benefits plans. As we’ve emerged from the pandemic, people are using benefits more than ever, and costs have gone up for most products and services, too.

ONE-T faces the added challenge of fixed funding. The amount allocated for each Member’s benefits is determined by the Provincial Government and is expected to remain fairly flat over the next couple of years. The ONE-T Trustees do not have any control over how much funding we receive.

Given the current level of funding, we anticipate that Plan changes will be necessary for the new Plan year that starts on September 1, 2025.

How funding works

The Trustees’ role is to ensure that the “account” remains balanced and sustainable.

With benefit costs rising faster than funding provided by the Province, the Trustees are required to use certain measures – including benefit reductions and cost-sharing with Members – to help make sure there is always sufficient “cash in the account” to pay Member claims.

Our plan management toolkit

With an imbalance in funding coming in compared to the claim costs going out, the Trustees explore three key areas:

Are there any possible administrative cost savings?
Are there additional ways to make delivery of benefits more cost-effective?
What is the magnitude and composition of changes that will contribute to Plan sustainability?

We’ve also developed plan design principles that guide the ONE-T Benefits Plan design and help ensure the Plan is managed responsibly and fairly. These principles include: maximizing cost efficiency, a focus on treating disease states, and looking after Members with the greatest (catastrophic) needs.

More information

Last fall, we held webinars, giving the ONE-T team and Trustees a chance to connect with Members on important Plan matters, like funding and plan design.

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