Every year the sanofi-aventisHealthcare Survey team goes acrossCanada to learn what plan membersreally think about their employer-sponsored health plans, theirperceptions of health and wellnessissues in the workplace and thecountry’s health care system in general.At a time when plan sponsors arefaced with both opportunities andchallenges, employee impressionsprovide valuable insights.

In 2011, 54% of Canadian employeessurveyed with benefit plans consider

theirs either “excellent” or “verygood”. This is down slightly from 59% last year, and may be attributedto job uncertainty. The value that plan members place on their healthbenefits and the role plan sponsorshave in health promotion and wellness are two key areas the surveydiscusses that can provide importantinformation to employers. Other topicscovered in this year’s sanofi-aventisSurvey include:

plan member perceptions on healthcare and the role of government

personal health and adherence to treatmentbenefits availability and use.

The full survey report provides valuableworkplace benefits information andhelpful employer tips. Go tohttp://www.sanofi-aventis.ca to read a copy of the full report.

1. The value of health benefits

Plan members continue to think highlyof their health benefits, although notas strongly as in previous years.

Maximizing employee engagement and productivityResults of the 2011 sanofi-aventis Healthcare Survey

Group Benefits

Fall 2011

news

In this issue

sanofi-aventis Healthcare Survey 1Maximizing employee engagement and productivity

eBenefit News 3The benefits of submitting claims online

What’s on your mind?® 4Clues to help detect mental health issues in the workplace

Wellness Report 6The real deal on detoxing

Trend Watch 8Orthotics, orthopaedic shoe and compression stocking claims

The Script 10Specialty drugs: Future trend driver

continued on page 2

E M P L O Y E E

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Communication also maintains aconsiderable influence: the better therating for communication efforts, themore positive respondents are aboutquality and loyalty to the employer.When offered a choice between theirbenefits and up to $20,000 in cash,48% of respondents preferred to keep their benefits, 38% would takethe cash and 14% were unsure. In2009, 47% said they would take the cash, 45% the benefits and 8% were unsure.

“I’m surprised these results havestayed this strong in light of theeconomic downturn and its lingeringhangover. You’d think more peoplewould take the money,” says MarileeMark, advisory board member andVice President, Group BenefitsMarketing Services at ManulifeFinancial. “There’s obviously a lot more awareness of the value ofbenefits, particularly as a safety net.”

Key findings

Plan members are less positiveabout both the quality of theirbenefits and their sense of loyaltyto their employer, which mayreflect changing expectations. A recovering economy likely plays a role in changingexpectations, as employees are less concerned about losing their jobs.

Older plan members prefer benefitsover cash and appear willing to pay increased premiums tomaintain benefits. They are alsomore likely to pay out of pocket for drugs not covered by their plan.

2. The role of the employer in healthpromotion and wellness

Plan members certainly agree that theiremployers should promote health,though their role should be access to

information and services rather thanthe management of personal health.However, notable differences ofopinion occur by region, gender andtype of work. The actual availability of wellness programs continues to decline according to plan members,despite the fact that the majority of surveyed plan sponsors say they are active in this area.

Key findings:

Improved and tailored marketing isa good opportunity to improveemployees’ perceptions of theavailability of wellness programs. Plan members rank flexible work hours at the top of a list of initiatives to encourage health, in terms of both availability and utilization. Low utilization rates do notnecessarily lessen the value of awellness program; diversity isrequired to meet differing needsand states of readiness. Organizational health lays thegroundwork for wellness, and planmembers and employers alikerecognize workplace stress needsto be addressed more effectively. A successful health and wellnessstrategy addresses plan memberswith disease states while trying atthe same time to keep the healthypeople healthy.

Employer tips & tactics to promote health and wellness in your workplace

1. Make flexible work hours a priority to support work/life balance and encourage employees to take their lunch breaks.

2. Train managers to be the formal liaison with the employee assistance program (EAP).

3. Partner with health care providers, public health agencies or health organizations to host regular on-site screenings for health risks.

4. Don’t just communicate your wellness offerings, insert them in your overall business strategy, market them and seek to measure

health outcomes.

5. Use management to communicate with and to engage plan members. To rouse curiosity and secure buy-in, use online and print

media, personal testimonials and small incentives.

Employer tips & tacticsto add value to yourhealth benefits plans

1. Invite employees to sit as

members of the benefits

committee so they can

appreciate the

decision-making process

and bring forward ideas.

2. When communicating

benefits information, always

include the costs to both

employees and employer.

Market the value in terms

delivering peace of mind.

3. If you’re a smaller employer,

consider collaborating

with others in your sector

to generate savings and

pool your risk.

Material provided by sanofi-aventis 2011

FALL 2011 3

Canadians are doing more and moretransactions online, from paying ourbills to filing our income taxes.Submitting group benefits claimsonline is a natural next step and hasbecome increasingly popular for itsconvenience and speed.

Offering your employees the choiceof using a quick and convenientonline method of submitting claimscan add value to your benefits planbecause it’s free and can increaseyour members’ overall satisfaction.

Getting started

The process for plan members isquick, easy and secure. They login tothe Group Benefits Secure Site, enter

the information requested found onthe receipt from their provider andsubmit the claim. Members arealways asked to keep their receipts in case their claim is selected for arandom audit, so plan sponsors havethe assurance that claims being paidonline have the same stringentcontrols for fraud prevention as the traditional claims process.

In order to use online claimsubmission, plan members mustprovide direct deposit information.This allows your plan members toreceive claim payments up to 70%faster. They receive an email whentheir claim is paid and the money is deposited straight into their bank account.

Plan members also have the option of viewing their claim status, claimshistory, and electronic claimstatements online. These statementscan be printed to submit to anotherinsurance company if an employee is coordinating benefits with theirspouse. At Manulife, if both spouseshave the same insurer as theirbenefits provider, the coordination of benefits is done automatically as part of the online claims process.

Help your employees get the mostout of your group benefits plan byencouraging them to use onlineclaims for their most common health and dental claims.

eBenefit News

The benefits of submitting claims online It's quick, convenient and easy

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Clues to help detect mental healthissues in the workplace

What’s on your mind?®

How do you recognize amental health concern?

Here are some clues that mayindicate an employee is sufferingfrom a mental health concern. It’simportant to remember that thepresence of these symptoms orbehaviour patterns do notnecessarily mean that an employeehas a mental illness, however, incases where performance hasbecome an issue, you may want totake them into consideration.

Absenteeism

An indication that there might be a problem is when an employeestarts missing a lot of work andbegins calling in ‘sick’ for a variety of reasons.

Presenteeism

A harder to notice clue that may be even more revealing is when anemployee is at work but is lessproductive or not getting thingsdone the way they used to. This isknown as presenteeism and theremay be more people impacted bythis than you think. Often theemployee will start to isolate him or herself and avoid others. They may no longer eat lunch in the lunch room or go for coffeebreaks with their colleagues.

Brain clues

Since a mental health condition may be affecting the employee’scognitive functioning, or the way inwhich they make decisions, you may

want to look for clues related totheir thinking and behaviour. These ‘brain’ clues might include aninability to concentrate, missingdeadlines, not finishing things, ormaking more mistakes than usual.Sometimes out of embarrassmentand fear of getting fired, theemployee may hide these symptomsfrom their manager and others. They may lose energy, interest and motivation for the job as a symptom of slower brainfunctioning.

You can also look for other clues like how they get along and interactwith their co-workers. They mayhave mood swings, or be irritable,argumentative, angry, difficult,tearful, down or sad.

FALL 2011 5

Physical clues

Sometimes the employee doesn’t say a thing but their body languagemight give some clues. You maynotice that they look like they havestopped taking care of themselves,have poor hygiene or appear to have slumped shoulders. They mayalso move slower than usual, not beable to sit still or become physicallyaggressive. Even the way they talkcan be a clue. They may speakslowly and quietly, or exhaust youwith their fast nervous talk,repetitive worries, comments, yelling, swearing, etc.

Pay attention to the clues but don’t jump to conclusions

You may simply notice thatsomething has changed with theemployee or that things just don’tseem quite right. Make sure youstop, take a look and listen if youthink something is wrong. Use yourpowers of deduction before jumpingto any conclusions about anemployee who may be havingdifficulty. If you think there areenough clues to indicate thatsomething is wrong, you may wishto have a private chat with the

employee and discuss anyperformance issues or unusualbehaviour. During this discussion,you may suggest that if they needhelp, they may use the EmployeeAssistance Program or any otheravailable resources.

Paying attention to changes inbehaviour may help you determine ifan employee is suffering from amental health concern and help youto manage these types of situationsin your workplace appropriately.

Introducing 'What's on your mind?®'

Manulife recently launched a new section on our Workplace Solutions for Mental Health website called 'What's on your mind?®'.

'What's on your mind?' contains easy to understand information and reliable tips for employees and employers aboutworkplace mental health issues. It currently features short information videos and articles developed with Dr. ThomasUngar, Associate Professor at the University of Toronto and Chief of Psychiatry at North York General Hospital in Ontario.

We will continue to expand 'What's on your mind?' by adding new material we develop in association with variousleading mental health professionals.

Visit Workplace Solutions for Mental Health at www.manulife.ca/mentalhealth.com

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You may have heard of detoxing –a process to rid your body of thetoxins you've built up from badfoods and the environment. Moreand more people, especially theoverstressed, time-strapped, andnutrition-starved, are turning todetoxification to improve their dietsand cleanse their systems.

Detoxification

Detox is a naturally-occurringphysical process. The body rids itselfof toxic substances that collect in ourlymph and digestive systems through

sweat, urine and feces. These toxinstypically include air and waterpollutants and processed foodchemicals. The body first eliminatesthese toxins through the gut.Whatever the gut can't catch getsinto the bloodstream and passesthrough the liver and kidneys, which flush them out.

Detoxing regimens are promoted asa way of providing your body with a nutritional break so that it canbecome a better waste dumper andnutrient absorber. But there is noevidence that detox regimens

actually cleanse the body of toxins.Your liver and kidney already do agood job of removing most toxinsfrom the body. However, a detoxprogram that involves eating ahealthy diet (see “What should Ieat”) can help promote betterhealth. This type of detox programlasts about a week and involveseating a nutritious, well-balanceddiet that's high in essential vitamins,minerals, fibre, and antioxidants,drinking plenty of water and clearfruit juices, and getting enough rest.You can also incorporate moderateexercise into your routine.

Wellness Report

The real deal on detoxing

What is detoxing NOT about?

The main misperception about detoxing is that you need to go to a dietary extreme or buy expensive ‘detox systems’ toachieve results. Steer clear of detox plans that include water fasts, juice fasts, and combination water-juice fasts – or fastingaltogether. Fasting can lead to headaches, fatigue, dizziness, or abnormal heart rhythms. Detoxing is also not about usinglaxatives to clean out your digestive system. If you suffer from a chronic disease or medical condition, always consult yourdoctor before beginning a detox regimen.

For some there may be a spiritual element to fasting, but remember, your body needs nutrients and energy.

FALL 2011 7

What are the overall health benefits?

Detox enthusiasts feel these programs can help enhance generalphysical and mental well-being.Proponents of detoxing argue that ithelps you feel better, look better, andhave more energy. Although there isno evidence that detox regimensactually remove toxins from the body, eating a healthy diet like theone described in “What should I eat”is definitely good for your health.

Trying it as a short detox might even be your springboard to a morepermanent healthful diet.

Who should detox? Who shouldn’t?

Detoxing may be a good choice forpeople with diets consistently low inone or more essential nutrients, suchas certain vitamins or minerals, fibre,probiotics or antioxidants – peoplewho feel they can’t commit to aregular, healthy diet. A dietitian orhealth care professional can help you analyze what you're missing and what you need more of. It’simportant to talk to your physician or a registered dietitian to develop a detox plan that suits your body and health goals.

You should not detox if you:

are under 18 are pregnant or lactating have a gastrointestinal disordersuch as Crohn's disease,ulcerative colitis, or gastritis have an autoimmune diseasesuch as lupus or arthritis are training for an enduranceevent have any other serious healthcondition not listed here.

When should I detox?

Some proponents suggest schedulingyour detox around the new year - atime of renewal for many – or anytime you’re in an out-with-the-old, in-with-the-new mentality. Detoxing a few times a year may be beneficial.Like your car, your body also requiresregular maintenance. And ideally, youmight begin incorporating some or allelements of your detox diet into yourregular diet.

Eating better is your body's ticket toimproving your energy, preventinglong-term health problems, andachieving a general sense of wellness.When you're healthy and confident inyour body, it affects your whole life.You feel better, you're moreproductive at work, and you feel moreinspired to achieve anything you putyour mind to.

News items about the health effectsof many popular foods prompt us tothink in new ways about what weeat, what we shouldn't eat, and whatit's doing to our body. So if you'reready to put down the junk food andsweets and commit to eating better,you might also want to considerdetoxing.

Material provided by © 1996-2011 MediResource Inc.

What should I eat?

A detox diet varies fromperson to person based ontheir age, gender, fitnesslevel and dietary restrictions,but in general it shouldinclude:

whole grain foodsprobiotic yogurtsfruits and vegetablessufficient lean proteinsources, such as chicken,egg whites, and salmonample water and clear natural juices.

Having enough colour andvariety in all the food youeat is key so that all the foodgroups are represented.

For more tips on healthy living,visit Health eLinks® on the

Plan Member Secure Site atwww.manulife.ca.

®

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Manulife Financial Group Benefits iscommitted to protecting our plansponsors and members from benefitfraud. Claims for orthotics,orthopaedic shoes and compressionstockings must meet specific criteriain order to be considered eligibleunder a group benefits plan.Inappropriate and deceptivepractices will result in denial ofclaims and these claims mayconstitute fraud, putting the benefitplan and you at risk.

What you shouldn’t do

Doing any of the following can beconsidered fraudulent, and have

consequences for the supplier andyou, the plan member.

You must not sign blank claimsforms and then let the providercomplete and submit them. Yoursignature makes you responsiblefor what is submitted. All claimsmust be submitted by you.You should not submit claims for free products offered as areward for using a supplier.You must not submit a claim for reimbursement before youreceive the product or obtain the service.You must not submit the claimbefore you pay for the product.Do not allow the provider to bill

your credit or debit card and then reverse the charge,exchange cheques (you pay theprovider, he pays you back) orfake a cash transaction. This isconsidered falsifying evidence of“proof of payment”.Do not state that the product has been received if it hasn’t.Do not obtain products forfriends or family members notcovered under your benefit plan.Do not be enticed by offers offree shoes or other products. Ifyou or your family members needstock item sandals, running shoesor work boots, seek a good dealbut pay for them yourself.

Trend Watch

Orthotics, orthopaedic shoe and compression stocking claimsImportant information for your plan members

FALL 2011 9

How you can protect yourself

Use the benefit plan for its

intended purpose – the medically

necessary treatment of illness or

injuries – and not as a means of

being reimbursed for products and

services not covered by your plan.

Reduce your risk by using

reputable service providers.

Educate yourself about the

product and its intended purpose.

See Buying custom-made

orthotics on the plan member

site under Fraud Prevention

Services, Educational Materials.

In the course of an audit or

investigation, Manulife may ask

you questions to determine the

eligibility of your claim. Your

response forms part of an official

claims record and will be relied

upon to determine payment.

Misrepresentation or omission

of requested information may

constitute fraud. Provide clear,

honest answers so we can

fulfill our obligations to your

employer as the provider of

your benefit plan.

Orthotics, orthopaedic shoesand compression stockings

If you think you need these products

to treat a medical condition, the

first thing to do is to be properly

diagnosed and assessed by a

credible health care provider. If it

is the professional advice of the

health care provider that you have

a medical need for one or more of

these products, take the time to

look for a reputable provider.

Once you have obtained the eligible

product from a provider and paid

for it, follow the claims process.

Fraud impacts everyone as it can

lead to increased benefit plan costs

and higher premiums. Manulife is

committed to protecting our plan

sponsors and members from the

risk of fraud. Our Investigation

Services team, comprised of former

law enforcement professionals,

investigators and analysts, watches

for and investigates inappropriate

activity. These investigations may

result in complaints to law

enforcement and regulatory

bodies, and in the case of fraud or

criminal activity on the part of the

plan member, we will inform plan

sponsors.

These regulators can provide more information on standards of practice:

British Columbia British Columbia Association of Podiatrists (BCAP) (604) 602-0400www.foothealth.ca

Alberta Alberta Podiatry Association (APA) (780) 453-5883www.albertapodiatry.com

Saskatchewan Saskatchewan Association of Chiropodists (SAC) (306) 691-6405

Manitoba College of Podiatrists of Manitoba (COPOM) (204) 942-3256www.copom.mb.ca

Ontario College of Chiropodists of Ontario (COCOO) (416) 542-1333or 1-877-232-7653www.cocoo.on.ca

Quebec Ordre des podiatres du Québec (OPQ) (514) 288-0019or 1-888-514-7433www.ordredespodiatres.qc.ca

New Brunswick New Brunswick Podiatry Association (506) 632-9422

If you have any information about deceptive and potentially fraudulent business

practices, please let us know by calling 1-877-481-9171. We all have a role to play

in protecting the integrity of group benefits. Let’s fight benefits fraud together.

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While commonly known as biologics,specialty drugs actually encompass amuch wider range of medicationsthat are impacting private plans.These may not be exclusively biologicdrugs in the strict sense, as some small molecule drugs, which are not biologic, may beconsidered to be specialty drugs. A specialty drug is defined as a drug having one or more of thefollowing characteristics:

requirement for frequent dosage adjustments and intensive clinical monitoring todecrease the potential of adverseeffects and increase probability of improved outcomesneed for intensive patient trainingand compliance assistancelimited or exclusive productavailability and distributionspecialized product handlingand/or administrationrequirementsgenerally, cost in excess of $500 per 30-day supply.

The growth in the introduction anduse of specialty drug products will be the most influential factor driving future drug trend. It isimportant to note that in contrast to small molecule drugs, theintroduction of “generic” biologics will not provide the samecost savings. These products will be classified as subsequent entrybiologics (SEBs) (also known as

biosimilars or follow-on biologics)and will be subject to similarregulatory requirements as theoriginal products they are intended to replace.

The increased degree of clinicaltesting and complexity ofmanufacturing will not permitequivalent cost savings that genericproducts for small molecule drugsprovide. In addition, pharmacists

Specialty drugs: Future trend driverThe Script

FALL 2011 11

will not be able to automaticallysubstitute the reference drug with an SEB because they will not bedesignated as therapeuticallyequivalent. However, not all specialty drugs are biologic products, so generic products forsmall molecule specialty drugs (e.g., oral cancer drugs) may become available in the future.

The components making up thespecialty drug trend of +13.2%, as shown above, are utilization(+5.2%) and cost per prescription(+8.0%). Specialty drugs accountedfor 17.5% of total drug spend in

2010, up from 15.9% in 2009.Specialty drug spend continues to be concentrated in just a fewtherapy classes. Specialty drugs for Rheumatoid Arthritis and related inflammatory conditionsaccount for close to 40% of all specialty drug spend.

The top five specialty therapy classes

represented 76% of all specialtydrug spending during 2010. Using available information on the current and anticipated rate ofgrowth, specialty drug spending is anticipated to grow by 40%

over the next five years. Based onthis, specialty drugs are estimated to account for approximately 25% of all drug spending by 2015.This will make specialty drug growththe key driver of overall drug spendin the coming years.

New drugs to watch

Specialty drug approvals continuedthroughout 2010 and many similarthemes are present as in previousyears. Continued development ofhigh cost biologic medications forrare diseases (e.g., llaris, Vpriv) aswell as oral cancer medications (e.g., Thalomid, Votrient) appearedonce again. Meanwhile there werealso some interesting new traditionaldrugs that were released includingVictoza for diabetes which belongsto a new class of medications (GLP-1 analogues), a newmedication for gout (Uloric), and new oral anticoagulants forspecific patient populations (Pradax, Effient).

For a copy of the Express ScriptsCanada (formerly ESI Canada) 2010Drug Trend Report please contactyour Manulife Account Executive.

Material provided by Express Scripts Canada ®.

=

Express Scripts Canada® is a wholly-owned subsidiary of Express Scripts Inc., one of the largest pharmacy benefit management (PBM) companies in North America (Nasdaq: ESRX). What’s on your mind?® , Health eLinks® , Health for Life® , Group Benefit products and Secure Sites areoffered through Manulife Financial (The Manufacturers Life Insurance Company). © 2011 The Manufacturers Life Insurance Company. All rights reserved. What’s on your mind?, Heath eLinks, Health for Life, Manulife, Manulife Financial, Manulife Financial For Your Future logo and theblock design are trademarks of The Manufacturers Life Insurance Company and are used by it and its affiliates under license. 09/2011

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Employee Benefit News is published each spring and fall to provide information of interest and of value to plan sponsors. Articles are not intended to provide medical, financial or legal advice andreaders are encouraged to direct their inquiries to the appropriate professional. For specific benefitsinformation pertaining to your plan design, pleasecontact your Manulife Financial Representative.

You can view Employee Benefit News and our other Group Benefits newsletters by going towww.manulife.ca/gbnewsletters.

Comments and feedback on our newsletters are always welcome and can be sent to the editor at group_bulletins@manulife.com.

Manulife Financial is not responsible for the availability or content of external websites.