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Not for Profit, All for Doctors:
the facts about OMA Insurance
Bruce Palmer
12/17/2014
Earlier this year, OMA Insurance launched a new brand, complete with a new tag line: Not for Profit, All for Doctors. We promised to provide unbiased, professional advice, and to do so in an altruistic, helpful, and objective manner.

Physicians have taken notice, and are asking questions. But some of the questions are more difficult to answer than others, and sometimes physicians speak to non-OMA advisors who are less familiar with OMA Insurance offerings and who may provide erroneous, incomplete or outdated information.

While the OMA cannot control what others say about its insurance program, we do have a duty to provide complete and accurate information so that members can make the best decisions possible to address their specific insurance needs. 

In that spirit, below are examples of inaccurate statements, and misunderstandings, occasionally expressed with respect to the OMA Insurance program, followed by clarification from the OMA.​​​​

 

​​​​​ Myth: OMA Ins​urance policies are written to benefit the OMA, while other insurance
policies are written to favour the insured.

 

Fact: OMA Insurance has direct input into the coverage provided by our insurance providers. As part of the Ontario Medical Association, OMA Insurance is governed by the OMA Board of Directors, composed entirely of physicians, and by the Board Insurance Committee, of which the majority of members are physicians. 
 
By contrast, the policies of for-profit insurance companies are written by those companies according to their own terms and specifications in order for them to achieve their corporate objectives. 

For-profit companies report regularly to groups such as business analysts, bondholders and shareholders, all of whom measure the success of the company not by the benefits bestowed upon their insured clients, but by the profits they generate. The executive teams of for-profit insurance companies are rewarded for reporting profitable numbers to these groups, and their success is measured by factors such as how much their company’s share price increases, and the size of their company’s shareholder dividends. 

The success of OMA Insurance, on the other hand, is measured based on the satisfaction of members, and staff salaries are based on the program’s success in delivering value to physicians and their families. 

When OMA Insurance has money left over from group policies after paying claims and expenses, it provides a refund to policyholders (i.e., physicians), not more bonuses to staff or dividends to shareholders. In December 2014, OMA group insurance policies returned $37 million in premium    
refunds to Ontario physicians.

 

​​​​​ Myth: With OMA Insurance, your policy is a group policy: you do not own it, the OMA does.
That means it can be cancelled at any time.
​​​ 
Fact: Not all OMA policies are group plans: home and auto, travel, clinic, and Earlier this year, OMA Insurance launched a new brand, complete with a new tag line: Not for Profit, All for Doctors. We promised to provide unbiased, professional advice, and to do so in an altruistic, helpful, and objective manner. Ontario Medical Review 2 December 2014 OMA Insurance Upda te some life and health plans are individual plans. With respect to OMA group plans, such as our Disability or Life Insurance plans, it is true that the OMA Board of Directors has the legal right to instruct OMA Insurance to cancel a group policy — a highly unlikely scenario given the Board itself is composed entirely of physicians who may be OMA group policyholders. The insurance companies that provide group policies on behalf of the OMA cannot cancel these policies: OMA Insurance contracts explicitly remove this right from these companies.

 

​​​​​ Myth: OMA Disability Insurance requires you to do an income assessment
before receiving your benefit.
Fact: If the insured individual is totally disabled, the OMA Insurance Disability policy pays out the coverage limit. Partial and residual disability is based on earned income (the idea being that people should not earn more working part time than they would full time).

 

​​​​​ Myth: If you have a claim, you are stuck dealing with an insurance call centre,
there is no specific individual assigned to assist you.
Fact: Virtually all insurance companies operate claims call centres, OMA insurers included. Generally, this is an effective way to serve you since the vast majority of claims, including home, auto, clinic and travel, are settled quickly and professionally through the insurer. That said, the OMA will intercede — if asked to do so by a member — when there is a dispute or disagreement between the insured member and the insurance partner. And, since the OMA is a significant partner with its insurers, the OMA can affect and influence what gets paid (keep in mind, however, that some claims, such as automobile accident benefits, are subject to intense regulation and are often difficult to affect). 

Moreover, since OMA Insurance is part of the insured physician’s professional association, and insurance staff are employed by and paid through the OMA (we are not employees of the insurers), the OMA has no conflict of interest in representing its physician clients in a claims dispute or disagreement. 

For Disability claims, an independent consultant is available through the OMA to work with all physician claimants to handle their paperwork and manage the submission process. In fact, the consultant will assist with all disability policies, not just the policies that the claimant has with the OMA. The consultant’s sole role is to assist claimants in making their claim, not to adjudicate claims. The consultant’s success is measured entirely in terms of the effectiveness of the assistance provided to the physician claimant. 

 

​​​OMA Insurance puts member interests first, and we put member insurance protection needs ahead of revenue. In other words, we exist solely to improve the lives of physicians.​
 
To ensure the best possible service is provided to members, the OMA also follows up on disability claimants with satisfaction surveys (issued directly from the OMA, not from the insurer), and claim trends are reviewed regularly. 

​Please keep in mind that although OMA Insurance will advocate on a member’s behalf, this does not mean that every claim submitted is paid. Policies deliberately insure some events and not others — this is usually done in order to maintain affordable costs for all. OMA Insurance will work tirelessly to assist a member when a claim is a covered event, or if there is an area of uncertainty, but the Insurance program has a duty to all its OMA policyholders to ensure that rates do not rise immensely in the future by paying for unintended claims today. This link between paying covered claims and rate stability is true of all insurance policies, and an agent or a broker who says otherwise is simply not stating the truth. 

In 2014, OMA insurance policies paid out over $47 million in claims from OMA members and their families.​
 
​​​​​ Myth: OMA Insurance will just push you into group insurance.
They cannot help you with other needs.
Fact: Unlike brokers and agents who cannot offer group products, OMA Insurance is a licensed life insurance agency and property and casualty insurance broker with access to both group and individual solutions. While OMA Insurance does believe that its group products are a sensible starting point for most members, it frequently recommends supplementing this coverage with individual coverage and, if it’s right for the client’s specific need, may recommend avoiding the group coverage altogether.
 
​​​​​ Myth: OMA Insurance just does insurance. If you want financial planning and
investment advice you will have to go somewhere else.
​​ 
Fact: OMA Insurance is deliberately focused exclusively on insurance and does not believe you should try to mix protection with wealth generation, as they are fundamentally different. 

The safety and security essential in protecting yourself from harm are different than the risks you want and need to take to translate your income into long-term wealth. The OMA believes it is important to build a strong foundation and to not confuse the tools needed to protect yourself and your family with the tools needed to grow. Covering the basics and managing risk are the foundational steps to building a successful, thoughtful financial future. Since 1956, OMA Insurance has been looking after the future of Ontario’s physicians. 

OMA Insurance works very closely with MD Physician Services (part of the national CMA group), which is another physician-controlled company focused exclusively on doctors and their families. MD does handle financial planning and wealth management, and, at the option and consent of the member, the OMA will share information to help co-ordinate the solutions offered.   
       
​​​​​ Myth: OMA Insurance products are expensive and have
all sorts of options you don’t want or need.​

Fact: OMA Insurance products are regularly bench-marked against the marketplace and offer very competitive rates. Moreover, OMA places its insurance business with top-rated companies that meet the highest standards of compliance and financial integrity. 

The OMA does offer many insurance options in order to ensure members have access to the solutions and choices that are right for their specific situation. When agents or brokers leave out options, they are taking away the client’s ability to customize their insurance solution. OMA insurance staff speak at length with members to understand their needs and desires before offering recommendations. Not all options may be right for you, but not having options limits your ability to properly manage your situation.​
    
​​​​​ Myth: OMA Insurance is not really non-commissioned;
they get paid just like everyone else.​​
Fact: OMA Insurance does earn revenue on the solutions it helps members purchase: there is a 6% fee earned from OMA core group plans (the plans that feature annual premium refund opportunities), and anywhere from 3% up to 25% (and sometimes more on individual life insurance products) on some other products. Overall, OMA Insurance fees average just under 7%. By comparison, members are encouraged to ask other agents, brokers, and advisors what their company earns in sales commissions (and don’t be misled if they claim that you only pay them a fee if they do planning: inquire what the insurance companies and other financial firms pay them as commissions, fees, and bonuses). 
 
At OMA Insurance, these fees are paid to the company — either OMA Insurance Inc. or the OMA itself — and not to the individuals who provide the service. OMA Insurance staff do not have access to any tool, table, or calculator that would tell them in advance how much a fee would be on any sale. All staff are paid a salary and can also earn bonuses for accomplishing goals — both as individuals and as a department. Individual goals are usually based on activities or projects; department goals are based on items such as total premium growth in OMA policies, number of physicians we have helped purchase one or more product, insurance client satisfaction, number of physicians spoken to within a year, etc. Overall, OMA Insurance bonuses reflect less than 10% of staff base salaries. 
 
The revenues that OMA Insurance brings in mean that the program is entirely self-funding: the Insurance Department uses no membership fees to cover its costs, with all of its expenses covered by the fees it is able to generate.
    
​​​​​ Myth: At OMA you are just a number, they don’t treat you
as individually as a local agent can.​​​
Fact: As employees of the OMA, the first job of Insurance staff is to deliver a valuable member service. The Insurance program’s ultimate success is measured by member satisfaction. More to the point, the advice provided is individualized to each member, and is built on a foundation of understanding the needs, careers, and lifestyles of physicians. 
 
Frankly, the goal of OMA Insurance over the coming years is to make its advice even more customized for members, and to provide the tools to help members analyze their own individual needs and to research the insurance offerings that will best address those needs. 

On A Personal Note 

I have worked for large and not-so large insurance companies, in communities big and small. I have been on insurance teams that range from two people focused on emu farmers in southern Ontario to global groups trying to harness the synergy in a multinational team. But I have never worked on a team so clearly and singularly focused as our team at OMA Insurance. 
 
We put member interests first, and we put member insurance protection needs ahead of revenue. In other words, we exist solely to improve the lives of physicians. In fulfilling our role, we talk to members about their needs, goals, aspirations, and priorities. When it makes sense, we start with the foundation of the OMA Priority Insurance Plan (OPIP) and Group products, and we try to encourage members to start looking after their needs when they are young and healthy — and while premiums are still low. 
 
Admittedly then, we are not totally objective: we have a bias for helping physicians. We will always be members’ professional, personal, physician- only insurance advisor. 
 
And we mean it when we say, “Not for Profit, All for Doctors.”​
​OMA Insurance is here to help. For insurance solutions designed to meet doctors’ needs, call 1.800.758.1641 or email us​.