As access to primary care erodes and chronic disease surges, stale group plans are quietly driving burnout, absenteeism and runaway costs
Canadian employers are paying more than ever for health benefits, but many workers still encounter slow reimbursements, confusing tools and long waits for care. That disconnect is fuelling concern that employer‑offered health insurance has fallen badly behind modern expectations.
In a recent interview with Canadian HR Reporter, Mark Goad, Canadian general manager at digital health and insurance provider Alan, did not mince words.
“My word for you would be ‘stale’,” he says of the current state of employer‑offered health insurance in Canada. “We hear a lot of talk about innovation and prevention and access... but the solutions that are being offered aren’t solving the challenges of the day.”
Goad argues that employer plans now sit at a critical junction in the wider healthcare system. With millions of Canadians lacking primary‑care access and chronic disease on the rise, he said decisions made in the benefits room are directly shaping productivity, absenteeism and the long‑term health of the workforce.
Employer spending on wellbeing benefits has dropped significantly, falling by 13 per cent from 2022 to 2025, according to a report by Ben, a company specializing in benefits spending.
Missing pillar in group plans
Goad sees prevention as one of the biggest blind spots in traditional benefits design. He pointed to the fact that only about one in five Canadians meets the country’s 24‑hour movement guidelines, a benchmark for daily physical activity that has a direct impact on chronic disease risk. Sedentary lifestyles, he says, translate into higher rates of conditions like diabetes and heart disease – and ultimately into higher plan costs.
Those conditions hit employers twice, he says: first through extended health and drug claims, then through disability, absenteeism and presenteeism. Workers managing ongoing health issues are more likely to miss time, cut back hours or struggle to stay fully engaged on the job.
However, most plans are built to pay bills rather than change risk, says Goad, noting that wellness tools are often “sidecar” apps or point solutions bolted onto core coverage, with employee utilisation in some cases hovering around three per cent. In practice, he says, that means employers are funding programs that look impressive on paper but have little effect on real‑world behaviour.
“HR leaders have basically been choosing between a dollar rate and a percentage coverage co‑pay for 50 years,” he said. “What if we gave you something instantly to get ahead of that?”
Just 1 in 20 Canadian workers access employer-provided benefits for wellbeing, according to an earlier report from RBC Insurance.
Access to health care in Canada
If prevention is the slow‑burn crisis, Goad describes access to care as the immediate flashpoint. He cited estimates that six million Canadians do not have a family doctor, pushing many to delay treatment or rely on emergency rooms for non‑emergent issues. For employees, that often means late‑night hospital visits and missed shifts.
Canada ranks near the bottom of OECD peers for same‑day or after‑hours access to a doctor, he says.
“You basically have to go to the emergency room,” says Goad, noting that many parents can tell stories of spending most of the night in an emergency department because they could not secure an appointment elsewhere. The next morning, those hours show up either in absenteeism figures or as exhausted workers trying to function on little sleep.
Even when staff remain on the job, the administrative load of navigating an overstretched system adds to presenteeism, he says, as comparing clinics, chasing referrals, worrying about out‑of‑pocket costs and managing complex treatment plans can quietly drain focus and energy long before a formal sick day is recorded.
Employer‑sponsored coverage is one of the few levers that organisations can pull in this environment, says Goad, and Alan has embedded a digital clinic into its app, funding initial mental‑health sessions and offering evening and weekend access, with plans to expand to family doctors and other providers. The aim, he said, is to divert appropriate cases away from emergency rooms and shorten the path to effective care.
The push for modernisation
Beneath the access and prevention issues lies an uncomfortable financial reality, Goad says. By global standards, Canadian benefit designs are generally solid; however, at 30% annual fees, Canadian small businesses pay some of the highest fees on earth for health insurance, he says.
“In the USA, the legal limit for small business health insurance fees is 20%. These high fees limit what we can pay employees, invest in innovation, and drive growth in our economy."
Small businesses in particular are paying some of the highest group insurance rates in the world, says Goad. Many have spent decades choosing between similar plans on the basis of rate and co‑pay levels, rather than fundamentally different approaches to health.
“You’ve essentially been choosing between a dollar rate and a percentage coverage co‑pay for the last 50 years,” says Goad of benefits decision‑makers. The result, he argued, is a “stale” status quo where employers feel they have little real choice beyond modest design tweaks and annual premium negotiations.
With roughly $60 billion a year flowing through Canadian group premiums, employer plans are poised to play a much larger role in how Canadians access care – and in how sustainable the wider system remains, he says.
More than half of Canadian workers are experiencing chronic health issues, with musculoskeletal, mental health, and cardiovascular conditions topping the list, accounting for 68 percent of long-term disability (LTD) claims, according to a previous report from Sun Life.
