Comprehensive List of Canadian Benefits Providers – Part 2: TPPs & TPAs
By Cindy Danielson
August 16, 2022
Part 2 of this blog series lists Canadian Benefits Providers called Third-Party Payor’s (TPP) andThird-Party Payor’s (TPA). While these providers don’t directly hold insurance risk, they are growing in popularity as they are a helpful option for employers wanting to minimize plan administration while getting the advantage of different benefits products and insurers. No one-size-fits-all with these providers😀. Part 1 lists traditional Group Health & Specialty Insurers.
This purpose of this two-part blog series is to help Canadian employers better understand the current marketplace of Canadian Benefits Providers to make informed benefits decision. Read Part 1 of the Comprehensive List of Canadian Providers that lists traditional Group Health Insurers and Specialty Health Insurers.
What is a TPP & TPA?
TPPs and TPAs were created to fill a gap in the insurance industry to better accommodate the growing complexity of employer-sponsored benefits including: multiple different plan designs, classes, locations, divisions and/or business units.
With a traditional insurer, employers found they were limited to the products solely provided by that insurer. Employers wanted more flexibility and product choice, but not the extra administration that came with it, so TPPs and TPAs were born.
TPPs and TPAs work with various insurers behind the scenes to package and price different benefits products from different insurers to offer more flexibility and, oftentimes, resulting in better coverage for the employee.
What's the Difference?
The main difference between a TPP and a TPA is that TPP’s do pay health and dental claims providing a seamless one-stop for employees. TPAs don’t pay claims so employees submit health and dental expenses directly to the provider insuring the benefit according to their claims process (e.g. email hard-copy forms, email digital forms or submitting digitally via an employee portal).
The list of TPPs receive, adjudicate and pay health, drug, dental claims directly to employees, with in-house claims staff (typically).
Some TPPs process claims manually via paper or digital claim forms while others offer technology such a plan administrator portal and/or employee portal (accessible via desktop and/or app) to make it easy for users to view coverage/submit claims.
It’s important to ask each provider their claims process to ensure employees are paid promptly and efficiently.
Insider Tip: Simply Benefits is Canada’s newest TPP with a modern, user-friendly platform that offers three unique portals for 1) employees (accessed via desktop or app) 2) employers and 3) benefits advisors.
A TPP’s claims management technology may be developed in-house or outsourced to a technology provider like:
ClaimSecure by Canada Life - Claims Management for Health, Drug and Dental Claims
HBM+ - Claims Management benefits Administration by hbm+
We can help. Contact us and we'll refer you to one of our Advisor partners.
List of Canadian Third-Party Administrators (TPAs)
TPAs do not typically adjudicate and/or pay claims therefore they may or may not offer a platform/technology for users. It’s best to seek the guidance of a Benefits Advisor to help you understand the best provider for your needs.
These providers are sorted alphabetically with direct links to relevant Group Benefits web pages.
Now that you understand the various benefits providers in Canada, we encourage you to consult with an experienced Benefits Advisor to help you understand their strengths and competitive advantages. Not working with an Advisor already? We would be happy to introduce you to one of our knowledgeable Advisors partners.
Other Canadian Providers
During our research, we also discovered these Providers:
Global Benefits/Expat Providers
If you are looking for international health insurance or expat life insurance, many Canadian insurers and some TPAs can assist; however, these two providers also specialize in global benefits:
Expat Financial, is a division of TFG Global Solutions Ltd., provides individual expats and their employers with independent advice and insurance plans from around the world.
Norfolk Mobility Group, is a TPA now known as MSH International, a provider of international insurance plans based in Calgary, Canada. MSH is a subsidiary of the France-based SIACI SAINT HONORE Group.
Benefits Provider for Self-Employed / Small Business:
Managing General Agent (MGA) for Group Benefits: MGA's are commonplace with Property & Casualty Insurance; however, they exist for group benefits too. MGA's typically work directly with Advisors/Brokers only - not employers. MGAs manage the contract between the broker and the carrier and do NOT pay claims. We share these MGAs for educational purposes only; however, as an employer, it's not directly relevant to you. To learn more about MGA's read: What is a Managing General Agent (MGA)?
Financial Horizons is an MGA for Life, Disability, Critical Illness, Health & Dental, Long-term Care, Travel, Group Benefits and Pension Services.
GroupQuest is a People Corporation company and an MGA.
Gryphin Advantage supports Advisors throughout the benefits process including the initial marketing, preparing a Sales Report, or facilitating the transition to a new insurer. They prepare client-ready Claims Analysis Reports and negotiates renewals within their large business blocks with major insurers to get the best value for clients.
Special Benefits Insurance Services is an MGA for Green Shield Canada’s Prism health and dental programs. They market and administer the Prism plans, while the billings, claims and risk are managed by Green Shield Canada.
Victor Canada is an MGA. Coverage is available through a licensed Canadian Plan Advisor.
Penad provides Third Party Administration of pension plan administration services, consulting, and actuarial services for pension plan sponsors in Canada and internationally.
Not on Our List?
If you are a Canadian TPP or TPA not on this list, or if you wish to provide feedback about this blog or your listing, please contact firstname.lastname@example.org and we'll review your request promptly. We appreciate your feedback and helping us to make our list as accurate and comprehensive as possible for Canadian employers.
Simply Benefits is a Third Party Payor (TPP) that provides Employee Health Benefits 100% digitally through our Canadian Advisor partners. Our all-in-one digital solution provides three portals that enableBenefits Advisorsto digitally manage all client plans online,Employersto efficiently administer employee coverage, andEmployeesto view, update and use their benefits 24/7 via desktop or smartphone app.
We helpENGAGEEmployees Anytime, Anywhere,SIMPLIFYthe Benefits Experience, andEVOLVEan Advisors’ Benefits Business.