Don't let cost be the driver in your benefits plan design

Rising claims.
Tight budgets.
Competing priorities.

If cost is pushing your benefits decisions, you don’t have to abandon your philosophy. You can protect your vision and your culture with intelligent plan design and disciplined reviews.

Define your north star (then price around it)

Start by naming what your plan is for.

Is it primarily protection against financial shocks?
Everyday wellness?
Talent attraction?

Pick one or two.

Then decide where you sit on the generosity spectrum: if 0 is ultra-bare-bones and 100 is “money-no-object”, are you a 90 or a 15 - honestly? Most Canadian employers land between 40 and 70. Put a stake in the ground. Your levers should point back to that target, not drift with every renewal.

Use intelligent plan design, not blunt cuts

You can lower trend without breaking trust. Focus on levers that protect outcomes and reduce waste.

• Prioritize value over volume. Fund what moves the needle: primary care access, mental health (with clinical pathways), and disability prevention. Trim areas with low clinical value or chronic overuse.

• Optimize the drug plan first. Maintain a robust formulary with prior authorization for high-cost drugs, mandatory generic where appropriate, biosimilar adoption per provincial guidance, and case management for specialty meds. Pair with pharmacy navigation and transparency on dispensing fees.

• Right-size paramedicals. Consider combined maximums, per-visit caps, or step-care (e.g., digital CBT before higher-cost modalities). Keep access, curb excess.

• Add a health care spending account (HCSA). Shift some discretionary spend to an HCSA to create flexibility without open-ended liability.

• Virtual-first care. Offer virtual primary care, mental health triage, and physio to improve access and reduce downstream costs.

• Out-of-country and travel. Calibrate limits and exclusions to real risk profiles.

• Disability and return to work. Invest in early intervention, evidence-based accommodation, and manager training. Shorter durations reduce total cost of risk.

• Fraud and abuse controls. Use plan audits, provider blacklists, and member education (e.g., red flags when a clinic asks your coverage before giving a price).

  Each move should be explainable to employees in one sentence. If you can’t explain it simply, rethink it.

Communicate like a steward, not a gatekeeper

Explain changes with empathy and math. Show how design tweaks protect coverage for what matters most. Use plain language, Canadian examples, and side-by-side comparisons (then vs. now). Reinforce responsible use: generic first, virtual first, avoid “package deals”, and report questionable provider behaviour. Employees want sustainability too - invite them into it.

Scenario plan your next 12 months

Build three paths - status quo, moderate savings, aggressive savings - against your generosity target (e.g., 55 out of 100). Map which levers you’d pull in each. Pre-draft member communications. Agree on decision triggers (e.g., trend > 10%, specialty meds +X%). When the renewal lands, you’ll decide in days, not months.

Cost pressure doesn’t require abandoning your values. Anchor your north star, choose high-value levers, align with public programs, review quarterly, and communicate clearly. That’s how you keep your vision intact while running a plan your CFO can live with - and your people can believe in.

For further reading, consider our companion piece: ‘The power of 4%: transforming employee benefits into a competitive edge’

Want a pragmatic plan design that protects your vision and your budget? People Corporation helps plan sponsors set generosity targets, tune levers, and run disciplined interim reviews. Reach out to get started.