Our take on plan administration 101, with the employee communications to go with it.
If you work in HR, you’ve probably seen a Plan Administration 101 document or three. Insurers hand them out at implementation, advisors send them at renewal, and they do a good job of explaining the rules.
This is our take, with a little extra. Alongside each rule, you’ll find the employee notice that goes with it: a ready-to-send Word template you can download, brand and share. Knowing the rule is half the job. Getting your people to act on it in time is the other half, and that’s where this kit comes in.
| Your plan contract is the rulebook This guide covers how most group plans work. Your contract and benefits booklet have the final say. The templates use highlighted [brackets] for every detail that comes from your contract, so fill them in before you send. |
How to use this kit
- Read the section for the moment you’re managing.
- Download the matching employee notice.
- Fill in the bracketed details from your benefits booklet.
- Add your logo and send it by email, Teams or your intranet.
1. New hires: eligibility and the 30-day enrolment window
The rule
An employee qualifies for group benefits once every condition in your contract is met. Typically, they:
- Are a T4 permanent employee (on your payroll, not a contractor) and actively at work. Exceptions may apply.
- Work at least the minimum weekly hours in your plan
- Have finished the waiting period, the stretch of employment before coverage begins. Exceptions may apply here too, such as a waiting period waived as part of employment negotiations.
- Belong to an eligible class or division
- Have provincial health coverage and live in Canada
Dependents have their own eligibility test. A spouse or child must also have provincial health coverage and live in Canada to join the plan. This comes up often when an employee moves to Canada ahead of their family. The employee can enrol right away, and their family can be added once they arrive and have provincial coverage.
| The 30-day enrolment window Enrolment must be complete within 30 days of the coverage effective date. That takes two steps: • The plan administrator submits the employee’s enrolment to the insurer within 30 days. • The plan member completes their own enrolment with the insurer: online account, dependents and beneficiary. An employee enrolled after 30 days becomes a late applicant. Late applicants answer medical questions, and coverage can be limited or declined. That carries liability risk for the employer: if coverage is declined because enrolment wasn’t submitted on time, the employer can be held responsible for the coverage the employee should have had. |
What HR does
- Check each new hire against every condition before enrolling them, not just the start date.
- Diarize the coverage effective date and the 30-day deadline that follows it.
- Submit your side of the enrolment, then follow up to make sure the employee has completed theirs.
- Confirm any waiting period waiver with your advisor before offering it, and put it in writing.
Why it matters
Enrolling inside 30 days means the employee and their family are covered from the effective date with no medical questions. It also keeps your organization clear of the liability that comes with a late enrolment.
2. Life events: adding a newborn or new partner
The rule
A birth, adoption, marriage or new common-law partner is a qualifying life event. The employee has 30 days from the date of the event to add the new dependent.
What HR does
- Tell employees at hire, and again whenever they mention a life event, that the clock starts on the date of the event.
- When an addition moves someone from single to family coverage, process the change right away rather than holding it for the next payroll cycle.
- Keep a record of the date you received each request.
Why it matters
Acting inside 30 days gives a new family member coverage from the start, with no extra paperwork. After 30 days, a new dependent, newborns included, is treated as a late applicant and may have to provide medical evidence.
3. Dependent children: age 21, students to 25
The rule
Children are covered until age 21. Children in full-time post-secondary studies stay covered until age 25.
As a child approaches 21, the insurer notifies the plan member that the child’s coverage is ending. If the child is a full-time post-secondary student, the plan member sends the insurer proof of enrolment to keep them covered. Any current proof of enrolment works; it doesn’t need to be for the fall term.
When coverage ends, there’s a 60-day window. A person leaving a group plan, including a child who ages out, has 60 days to convert to an individual plan. Converting inside that window means existing conditions and medications can stay covered. After 60 days, individual coverage means answering medical questions.
What HR does
- Remind employees to watch for the insurer’s notice and respond with proof of enrolment.
- Keep dependent birth dates and student status current in your records.
- Share the 60-day conversion window with families whose child is aging out, and with every departing employee.
Why it matters
A quick proof of enrolment keeps a student covered through their studies. And when a child does age out, knowing about the 60-day window lets the family keep coverage for existing medications without starting over.
4. Before you travel: the medical stability period
The rule
Some group travel plans exclude a pre-existing condition (a health condition that existed before the trip) unless it has been stable for a set period before departure. Stable usually means no new symptoms, no new or changed medication or dose, no new treatment, and no tests or results pending. Whether your plan has a stability period, and how long it is, depends on your contract.
What HR does
- Find out whether your travel benefit includes a stability period, and its length.
- Share the travel notice ahead of winter break, spring break and summer.
- Remind employees to call the travel assistance line before receiving treatment whenever they can, and to carry their benefits card and provincial health card.
Why it matters
An employee who knows the rule can plan around a medication change and travel with confidence. Calling the assistance line first usually means the insurer can bill the hospital directly, rather than the employee paying up front and waiting for reimbursement.
5. When an employee is off work: know your process
The rule
Every leave follows a process, and your employees should be able to see it before they need it. Start with three questions:
- How is short-term disability handled? If your short-term disability (STD) plan is insured, claims go to your insurer. If it’s self-funded, your organisation pays the benefit and a third-party adjudicator likely reviews the claims.
- What needs to be submitted, and by whom? Most disability claims need three pieces: the employee’s statement, the doctor’s statement and the employer’s statement.
- Who keeps paying premiums, and for how long? This depends on the type of leave: statutory, unpaid personal, short-term disability or long-term disability.
What HR does
- Map your process for each type of leave, step by step.
- Make sure your employee handbook details who pays premiums during each leave, and for how long.
- Confirm in writing, at the start of any leave, which benefits continue.
- Use Template 5 to share the policy with employees, pulling together your benefits booklet and employer policy in one place.
Why it matters
A documented process means every employee on leave gets the same clear answer, claims move without delays, and premiums are handled exactly as your policy says.
6. Year-end: spending accounts and claim deadlines
The rule
A health spending account (HSA) reimburses eligible medical and dental expenses tax-free. Unused HSA credits can usually be carried forward, as set out in your contract.
A wellness spending account (WSA) works differently. WSA reimbursements are taxable income for the employee (CRA). To keep that income in the right calendar year, it’s very common for WSA claim submissions to close on December 31. There is no rollover or carry forward. Unclaimed WSA dollars at December 31 are gone.
What HR does
- Send the year-end notice in October or November, with the WSA December 31 deadline front and centre.
- Confirm next year’s allocations with your insurer or advisor before their deadline, typically in the fall.
- Include the post-termination claim deadline in every exit package.
Why it matters
A clear, early reminder means employees use the full value of their wellness dollars, and every reimbursement lands in the right tax year.
Cheat sheet
Fill in the right-hand column from your contract once, then keep it handy.
| What to do | Employee notice | Your plan’s rule |
| Check eligibility; submit enrolment within 30 days of the effective date and confirm the employee completed theirs | Template 1 | [Waiting period / effective date] |
| Add new dependents within 30 days of a life event | Template 2 | [Common-law definition] |
| Collect proof of post-secondary enrolment for children turning 21 | Template 3 | [Age limits: 21 / 25] |
| Share the 60-day conversion window with departing employees and aging-out dependents | Template 3 | [Conversion window] |
| Share travel rules and the assistance number before peak travel | Template 4 | [Stability period, if any] |
| Follow your leave process; confirm who pays premiums and for how long | Template 5 | [Insured STD or third-party adjudicator] |
| Remind employees WSA claims close December 31 | Template 6 | [WSA deadline / HSA carry-forward] |
| Share the claim deadline in every exit package | Template 6 | [Days to submit after leaving] |
Frequently asked questions
We already have a Plan Administration 101 guide. Why use this one?
Those guides explain the rules to you. This kit adds the step that comes next: a notice for each moment that tells employees what to do and by when.
Can we waive the waiting period for a new hire?
Often, yes, as part of employment negotiations. Confirm with your advisor before you offer it, and document it in the offer letter.
Are contractors eligible for the group plan?
Group plans are generally built for T4 permanent employees. Contractors paid by invoice usually aren’t eligible, though some carriers allow contract employees-exceptions will apply.
An employee’s family hasn’t moved to Canada yet. Can we add them?
Once they arrive and have provincial health coverage. Until then, the employee can be enrolled on their own. Ask your advisor how your plan times the window to add them.
Can wellness spending account claims carry into next year?
No – and your accountant will thanks us. WSA reimbursements are taxable, so claims commonly close on December 31 and unused dollars don’t roll over. Health spending accounts are different and usually allow a carry forward.
What happens to coverage when an employee leaves?
Group coverage ends. The employee has 60 days to convert to an individual plan, which lets existing conditions and medications stay covered without medical questions. Learn more.
Can we edit the templates?
Yes. They’re Word Docs and meant to be a starting point. Add your logo, fill in the highlighted brackets and send them however your team communicates.
| Want every bracket in this kit filled in for your plan? A Healthwise Plan Clarity Review walks through your contract with you and maps your eligibility rules, leave process and spending account deadlines into one cheat sheet your team can run with all year. Request a Plan Clarity Review → |
This kit is general information about group benefits administration in Canada. Your plan contract governs. Confirm every rule with your insurer or benefits advisor before you act on it.
