Providing you with the support and the information that you need to best service your clients

Payors

First Canadian Benefits (FCB) values the relationships that it establishes with payors. We understand that your business depends on knowing what services are available to your clients and on keeping up with industry changes. Our goal is to provide you with the support and the information that you need to best service your clients.

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Why Enroll as a Payor?

Health and Dental benefit costs have been increasing significantly in recent years. Post pandemic recovery has resulted in cases that are out pacing the flow of contributions to plan funds. General economic conditions, regulatory changes, and ongoing uncertainty pose challenges on negotiating increased contribution rates into plans. Currently it is the patient who is bearing most of the fiscal responsibility. As plans gradually reduce coverages to meet costs, it is the patientwho assumes the greater copayment and out of pocket expense. Many of these patients are unable to pay for these out-of-pocket costs and inevitably do not have the treatment performed. As neglect and abstinence occurs, so does failing health and productivity in the workplace, inevitably resulting in the need for extensive treatment to bring the member back to their wellbeing.

There are in fact severe inequities and disparities in the delivery of health benefits. Technology, increased fee guides, inflation, and rising costs of materials dictates the need for more funds. Payors (Public members, insurers, third party administrators (TPAs), corporations, trusts, organizations and multi-employer sponsored plans, all referred to as payors) must seek for solutions in an alternative delivery of care model to help sustain and maintain current benefits structures. It is only through our resources that payors can look towards funding these solutions. FCB integrates a contracted health network of providers, under clinical governance, to provide payors savings in compliance to industry standards. FCB integrates provider services as it offers its proprietary health network under reference-based pricing to payors. Payors savings produced are between 20-30% on all claims payable.

As a member of the FCB Health Network, Payors and their members can also expect to receive:
  • A benefit relief by utilizing our affiliate vendor program, allowing your members to save on goods and services such as medical supplies, sundries, and more.

  • Virtual Care by video calling one of our network providers at no cost.

  • Mail order pharmacy with a guaranteed lowest dispensing fee and free delivery.

  • Savings on hearing aid devices and vision care such prescription lenses and frames.

  • Online appointment booking to ensure you are making the most of your time.

  • Access to Health and Dental Providers across Canada in every discipline. Travelling? Not to worry, FCBHN has got you covered!


FCB has made great strides towards sustaining and maintain costs, by designing and building the network from the payors perspective. The result is a health network that offers the breadth, depth and features payors want. We have also adopted the recommendations of various provider associations as we embrace the better business practices, ethics and jurisprudence of managing health care.

How does it work?

FCB is a socially responsible company that is charity driven as it provides a social contract to all Canadians in need. We acknowledge the FCB Health network as they continue to claim and bill for services under reference-based pricing.

Payors and their representatives have two options for cost containment and affordable rates at no cost to the payor:

Option 1

Use FCB’s Covid 19 Health and Dental Relief Plan A001 as a standalone or supplementary plan. By utilizing and submitting claims through Plan A001 first, you will be saving 20-30% on all claims submitted while aligning with industry standard coordination of benefits (COB) for your secondary plan. In many cases payors can expect up to 40% savings by tailoring their plan with the FCB team under RBP.

  • * FCB providers are contracted to accept RBP for all health and dental services specific to their province.
  • * Option 1 allows members to receive more coverages with no annual maximums, deductibles, and reduced co-payments.Members will also have the opportunity to receive a myriad of goods and services at a reduced rate.

Option 2

FCB can adjudicate your existing plan under the FCB Health Network to save 20-30% on all claims payable by utilizing our FCB E-Portal under reference-based pricing. Members will also have the opportunity to receive a myriad of goods and services at a reduced rate.

Reference Based Pricing

Through the evolution of health and dental care, providers have determined their own prices. The result is a broad range of price variances from one provider to another!  The price of a procedure (big or small) will vary simply depending on where the procedure is taking place and who is performing it.

It’s no secret the high cost of health care has many employers feeling limited in their options and ability to provide quality benefits at an affordable cost. Several options exist beyond simply shifting costs to employees. One such option is reference-based pricing (RBP). RBP helps address the cost of care while also addressing employer concerns regarding the affordability of health care benefits.

What is reference-based pricing?

Reference-based pricing is a health plan strategy where the employer sets a ceiling on the amount it will cover for a procedure rather than having the provider determine the cost. Providers are then asked to accept the RBP payment, or provide justification as to why their fees exceed reasonable and customary charges.

To achieve optimal results for both the employer and member, integrating RBP in health and dental coverages requires specialized administrative capabilities best served by the FCB Health Network

Health plan coverage rarely covers the full amount of any procedure. Cost is typically covered by a combination of funding such as co-pays, deductibles, and plan coverage.

How RBP Works (Dental Example)

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  1. Health and Dental providers charge drastically different prices for the same procedure.
  2. Each province has an established “reasonable and customary” price for that procedure.
  3. The FCB Health Network uses reasonable and customary (i.e. reference-based) pricing to negotiate with providers to ensure that their employer and member clients are not over-charged.

Example of cost variance: Dental Crown

For example, the cost variance of a Dental Crown might range between $700 and $1100 or more across Canada. However, the quality of the procedure and care provided is basically the same. RBP eliminates the variance with a set amount and ensures a win/win/win scenario:

  • * The patient receives quality care at a more affordable cost.
  • * The provider receives fair payment for their services.
  • * The premiums begin to stabilize for the employer and employees.
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Benefits of RBP?

The objective is simple - address health and dental costs for individual employees and employers. The benefits of RBP however have a far reaching, ripple effect throughout the healthcare community. The intent is to provide an effective tool to help stabilize the cost of healthcare.

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Employees

RBP takes guesswork and worry from employees regarding price - specifically, out of pocket costs. It also encourages members to engage proactively in managing their health and dental costs.

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Employers

Managing cost is a primary motivator of employers choosing self-funded health plans. RBP leverages every opportunity to proactively achieve optimal cost management while still providing quality health care to members.

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Healthcare Community

Setting fair value pricing through RBP helps create a competitive market focused on improved results through quality performance at an affordable cost.

Frequently Asked Questions

 No, these services can be obtained in whole or in part based upon each client’s needs.

 FCB values its agent partners and will assist with any employer meeting, finalist presentation, employee enrolment or educational meeting when asked by the agent to do so.

 Yes, FCB provides claim adjudication and payment services for its covid 19 health and dental relief plan A001 and/or policies enrolling into the FCB Health Network.

 Yes, agents/brokers utilizing the FCB Health Network for their clients will be reimbursed accordingly.

Payors must first select “contact us” found in the payor tab and fill out the particulars allowing a member of the FCB Health Network Team to reach out.

 Plan members must be informed and engaged throughout their healthcare experience to ensure the right coverage outcome. Asking questions about the cost of a procedure is encouraged. Staying informed about providers who are RBP compliant is recommended. Patients still have a choice in using non-compliant providers but in doing so assume responsibility for the balance beyond the cost ceiling set by RBP.

Plan members will receive further coverages with no annual maximum, deductibles, and reduced co-payments under RBP. Members will also have access to affiliated vendors for savings on goods and services, virtual pharmacy, and savings on prescription glasses and hearing aid devices. Payors can see their premiums stabilize by saving up to 30% on all claims payable.