Third-Party Payor: How Does It Work?

Third-Party Payor: How Does It Work?

Though Canada provides universal healthcare to its citizens, our taxes do not cover certain health-related services. For example, though dental care, eye care, and prescription medicines are integral to maintaining a healthy lifestyle, they are excluded from the healthcare system. Thus, many Canadians rely on private insurance or group benefits through their employer to access these essential services. 

Private insurance through a third-party payor can reduce the cost of health care, leading to lower stress levels and improved beneficiaries’ health. Thus, investing in private insurance from a third-party payor can benefit your workplace by attracting top talent with your comprehensive benefits. Healthy and relaxed employees are also less likely to call off work.

However, finding a private insurance plan that suits the needs of your employees is stressful. What are third-party payors, and what potential benefits do they offer your workplace and employees?

What Is a Third-Party Payor?

When receiving medical care, a patient must end their visit by paying the healthcare professional. However, patients with insurance either partially or fully direct their bills to the insurance company. The insurer thus acts as a third-party payor for the patient. 

A third-party payor is any organization that covers certain healthcare expenses on behalf of an individual. Examples of third-party payors include insurance companies, health maintenance organizations, and other entities. Some third-party payers work with multiple companies to provide the best price for each privatized healthcare procedure to reduce overall expenses. 

When employers search for health insurance for their staff, third-party payors work with these clients to:

  • Formulate a suitable health care plan
  • Handle administrative work
  • Facilitate payment for health care services that the government does not cover.

Establishing an insurance plan with a third-party payor thus requires little effort from the employer, who must only work to coordinate their needs with the target insurer.

Third-party payors require beneficiaries to pay a bi-weekly or monthly premium. These premiums are often more affordable when an employer provides a group plan to their staff members. Group plans lower the overall expense of privatized medical care.

What Coverage Do Third-Party Payors Provide?

Third-party payors also offer plans that provide recipients with either partial or full coverage for their medical expenses. Coverage can include:

  • Mental health
  • Dental
  • Prescription medication
  • Physiotherapy
  • And more

Third-party payor plans vary based on the needs of the company and its employees.

Insurance plans provided by third-party payors include a deductible, the amount of money that a patient must pay out of pocket for their care. The insurer defines a deductible as either a lump sum for all medical expenses or an applicable amount based on the procedure that a patient receives.

For example, a third-party payor may require a patient to pay $5,000 out of pocket before covering any further medical expenses. Other third-party payors may require their patients to pay $50 on prescription medication before covering the rest of the cost.

Why Work with a Third-Party Payor?

Three of the most beneficial aspects of working with a third-party payor include: 

  • Improved financial well-being
  • Healthier employees
  • More productive workplace

Improved Financial Well-Being

Even with Canada’s universal healthcare, many Canadians need additional coverage for which they must pay out of pocket. According to the Canadian government, 48% of Canadians report losing sleep due to financial worry. Individuals that feel financial stress are also twice as likely to have poor overall health.

Private insurance can reduce the cost of living for many people. For example, individuals suffering from chronic illness may pay extraordinary amounts for their medications, physiotherapy, etc. A healthcare plan from a third-party payor could save them thousands of dollars every year in medical expenses.

Parents are also likely to benefit from private insurance. Children require extra orthodontic, dental, and emergency medical care for unforeseen accidents and illnesses. Providing parents in your company with private insurance can reduce the financial stress children add to everyday life.

Healthier Employees

According to the Canadian Life and Health Insurance Association, private insurance covers medical expenses for around 70% of Canadian citizens. Furthermore, insurers covered $26.6 billion in supplementary health costs for their policyholders in 2020 alone. Insurers also supported the mental health of Canadians during the pandemic by covering $420 million of claims to psychologists and mental health professionals.

Third-party payors provide the necessary support Canadians need to seek out medical attention. Healthy workers are less likely to call off work due to illness.

More Productive Workplace

A healthy staff leads to increased productivity at the office, as employees are less likely to feel distracted by their mental or physical health. According to the Canadian government, a distracted employee can cost a company $1,000 per year in wasted productivity. Employers can increase office productivity by improving financial well-being and reducing health-related stress. Better benefits and happier employees can also help foster a positive office environment, which can attract more skillful and hardworking staff. 

Thus, working with a third-party payor to provide your staff with health insurance can benefit office culture and profits.

Insurance Glossary for Small Businesses: Important Terms

Want to understand more about health insurance? Read our article on key insurance terms here.

How Group Enroll Can Help

If you are ready to start providing your employees with private health insurance, Group Enroll can help. We help you compare high-quality, affordable insurance plans that meet the requirements of your budget and your employees’ needs. 

To request a quote from Group Enroll, you simply fil out our quote form. We will promptly call or email you in two to three business days for more information on your situation, then send out your quote request to five to ten providers. After we receive their proposals, we will email you the most competitive offers.

Finally, you decide which third-party payor to use and set up your new plan. Group Enroll can save you time and money by streamlining the search for a third-party payor. We can find the best company to provide an affordable and comprehensive group health insurance plan to your staff. 

Get a quote today by filling out our convenient online form or contacting us at [email protected]. Our location is at:

10 Great Gulf Drive, Unit 5,

Vaughan, ON

L4K 0K7

We look forward to hearing from you soon.

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