Your Most Common Questions - from Plan Administrators

Benefits are an important part of your relationship with your employees and being a plan administrator is no small task. Between understanding coverage, supporting employees, and keeping everything running smoothly, it can sometimes feel overwhelming - but you’re not alone. Many employers and administrators have the same questions, and with the right support and guidance, managing your benefits plan becomes not only possible, but rewarding. 

Here are some of the top questions that frequently appear in our inbox.

The big question: What do I actually need to do as a plan administrator?

As the plan administrator, you are the main point of contact between your employees (plan members), the insurance carrier and your benefits advisor (us!). In your role, there are some critical things you need to know and some key things you need to do. Let’s break them down into more detail.

To Know: what you need to understand:

• The group contract policy: the legal agreement between your organization and the insurance carrier.

• The employee benefits booklet: the simplified, employee-facing document that helps plan members understand their coverage, claims processes and other important details.

• Definition of earnings: this is a critical component for any plan that includes salary-based benefits. 

• Eligibility rules: these are defined in the contract. 

To Do: your main responsibilities include:

• Enrolling new employees and their eligible dependents within contract timelines (typically 31 days).

• Submitting updates for salary changes, marital status, births, or other life events.

• Processing terminations and offering applicable conversion options (e.g., Life Insurance).

• Maintaining accurate records for coverage tier, earnings, and eligibility.

• Reviewing monthly billing to reconcile premiums, volumes, and salary changes.

• Distributing plan materials (benefit booklets, portal access instructions, updates) to employees.

• Monitoring timelines and contract rules to avoid late applications, claim delays, or tax errors.

Just as important as knowing what you’re supposed to do, is understanding what you’re not responsible for. As plan administrator, you don’t interpret or review private medical information - that’s handled by the insurer. You also aren’t the one making decisions about claim approvals - that’s up to the insurer too. You also aren’t responsible for offering legal or tax advice related to benefits - unless you’re a qualified professional in this area, we recommend referring your employees to someone who is. 

This might feel overwhelming, but we’re here to help. Captivate is your dedicated advisor and liaison to your insurance carrier. Here are some of the things we do on your behalf:

• Lead renewal strategy and negotiate rates with the insurers

• Consult on plan design changes (coverage, cost share, enhancements)

• Escalate complex claims or service delays with the insurer

• Deliver employee education sessions and onboarding support

• Train new Plan Administrators and provide ongoing guidance and day-to-day support

• Provide tools and templates (like checklists, reconciliation trackers, and more)

Understanding what you need to know and do is important - and knowing who handles can reduce confusion, delays, and unnecessary stress. However, if it feels complex, time-sensitive, or outside your comfort zone, contact us and we’ll help.

Second place: The company is paying money for these benefits, how do we make sure our employees are actually using them?

As plan administrator, your job is not only to manage the benefits offered to your employees, you are also responsible for effectively communicating what benefits are available and how employees can access them. It’s important to be proactive as well as responsive, so that employees know about their benefits before they need them. An effective communication plan is therefore critical and should be implemented at both key milestones and as consistent, frequent messaging. Implementing a communication calendar, where you outline what gets communicated and when, can be helpful. Here is an example: 

Key Moment	Purpose	Format	Timing
New hire onboarding	Introduce plan and enrollment process	Email + handbook	Within first week
Annual renewal	Share changes and reminders	Info session + email summary	Each renewal cycle
Life events (e.g., marriage, leave)	Explain options or changes	Targeted message, private communication	As needed
Ongoing education	Reinforce understanding, provide details about specific benefits that are available, communicate changes to the plan or provincial legislation	Newsletter / intranet post	Monthly or Quarterly

As your partner, Captivate can lead the way in benefits communication, working closely with you to deliver the right message at the right time. We don’t expect employers or plan administrators to be benefits experts, because effectively communicating coverage, options, and processes can sometimes require specialized knowledge and experience. Our goal is to ensure your employees understand and feel confident in their benefits, while relieving you of the complexity and stress that often comes with these conversations. Together, we can form a communication plan that works for you and benefits your employees. 

As important as outward communication is, being open and receptive to receiving questions from your employees is perhaps even more critical. To be a truly supportive workplace, it is very important to set a culture where it is ok to ask for help. In your leadership communications and behaviours, make it clear that employees can approach you if they need any kind of support or have questions about what’s available to them. That way, employees feel confident asking for help and proactively managing their own benefits usage. 

The final piece in ensuring that employees are using the benefits available to them is knowing, as the plan administrator, where to find the right information - about coverage, eligibility or claims processes. This is important so that when an employee does approach you with questions, you know where to get the full information they need about what your plan offers. Your portal is a good first starting place, but if you’re still not sure, contact Captivate and we can help. 

Another great question: How are benefits impacted when an employee is on leave?

The answer to this question, like to many others, is ‘it depends.’ In this case, it depends on the type of leave and the type of coverage. Certain types of employee leave can affect benefit eligibility, premium responsibilities, and whether certain coverages are paused, continued, or modified. Understanding the nature of each leave is essential to avoiding coverage gaps or billing issues.

There are some common types of leave which have implications for coverage:

• Maternity / Paternity Leave: Protected by employment standards; benefits usually continue, but cost-sharing may change. Optional benefits may be waived with consent.

• Short-Term Disability: Payment responsibilities may shift based on plan setup.

• Long-Term Disability: typically triggers the Life Waiver of Premium.

• Employment Standards Leaves - Includes family medical, critical illness, and compassionate care leaves.

• Unpaid Leave of Absence - benefits are not protected under legislation in these circumstances; continuation is up to employer and employee.

• Temporary layoffs - whether benefits continue during layoff period depends on contract and provincial rules.

It’s important to remember to update the employee’s status in the insurer portal to reflect any type of leave being taken. As each plan has unique rules, contact Captivate if you’re unsure how benefits are impacted in your employee’s specific leave situation. 

Last but not least: What do I need to do when new employees are hired or an employee leaves the company?

When an employee is hired:

• Determine the employee’s eligibility date for coverage (at the time of hire or after a probationary period).

• Send the benefits enrollment materials to the employee as soon as possible.

• Submit enrollment on the insurer portal within the timeframe, typically 31 days.

• Confirm your employee’s dependent information and eligibility.

• If using paper enrollment, keep all documentation in the employee’s file.

• Ensure that salary information is accurate - this is important for salary based benefits. 

It’s useful to create a recurring onboarding checklist with the key tasks that must be undertaken when a new employee joins the company, so that nothing gets missed. Standardized emails and document folders can also ensure this process happens seamlessly every time. 

When an employee leaves:

• Terminate their benefits in the insurer’s admin portal.

• Send conversion option details, if employees are eligible to convert their group coverage to an individual plan.

• Review the final billing to ensure that the employee has been removed. 

Changes in employee status are always a bit complicated. If you need more help navigating these changes in your business, please reach out so that we can help you manage these transitions with calm and confidence.

As a Plan Administrator, you’re the bridge between your team and the benefits that support their health, finances, and peace of mind. It’s a big responsibility - but you don’t have to manage it alone. Whether you’re processing a new hire, reviewing a claim, or navigating a complex leave, we’re here to offer straightforward answers, timelines, forms, and guidance. If you have any questions - about these topics or any other - please reach out and let us help. With even just a little bit of support, you will be able to handle your role with clarity and confidence.