Why plan sustainability and Plan Member wellbeing are colliding

Why plan sustainability and Plan Member wellbeing are colliding
Photo by Jess Barnett / Unsplash

For years, Plan Sponsors have chased a delicate balance: keeping benefits affordable and competitive while supporting the health of their people. On paper, it sounds simple. In practice, it’s never been harder. The 2025 Benefits Canada Report makes that tension crystal clear. 

Although the Benefits Canada survey, in our opinion, doesn’t and hasn't reflected the state of the average Canadian business which has under 100 Members (check out our notes on last years report), we still believe there are important insights to consider. 

The nature of costs 

Costs are climbing. Nearly two-thirds of Plan Sponsors say expenses went up again this year. At the same time, Plan Members are demanding more — and pushing back hard on any hint of reduced coverage.  

In fact, 80% say cutting back benefits to control costs would be unacceptable. It’s a collision that puts Plan Sponsors in the middle of two powerful, opposing forces. 

What makes it more complicated is that the investments Plan Sponsors are making don’t always seem to land. Mental health has been a major focus for several years, yet stress remains at record highs.  

32% of Members who described their benefits plan as poor also reported poor overall health. Among those who used up their coverage, nearly 70% reported the highest levels of daily stress. Some are turning to exercise — a positive trend, with a 50% increase noted — but it doesn’t mask the reality: resources aren’t easing the pressure as much as expected. 

Perception vs. reality 

There’s also a striking disconnect between perception and reality. Plan Sponsors estimate that about 38% of their Plan Members are living with chronic or lifestyle-related conditions, when in truth it’s closer to 59%. And while only a small share of Plan Members are using paramedical services to manage those chronic conditions, demand in other areas — like dental — is heating up.  

If you look at the numbers on coverage maximums, you can see where frustration peaks. 

Roughly 56% of Plan Members hit their maximums on a category, and if they do, 34% opt to stop the treatment they were doing entirely until the year resets. Plan Members are clear about what they want: don’t take coverage away. Some are even willing to pay more to keep it — 31% say they’d accept higher premiums, while another 23% would pay more only at the point of use. But few are willing to accept cuts. 

The big miss 

And then there’s the communication gap. There is a 13% disparity between Plan Members (71%) and Plan Sponsors (84%) on whether the plan in place is excellent or good, the biggest gap since 2020. Plan Sponsors are happier with their plans than they’ve been since 2022.  

The disconnect couldn’t be sharper: one group feels the story being told isn’t theirs, while the other believes the narrative is improving. That misalignment, if left unchecked, could undermine both sustainability and trust. 

So where does this leave us? Stuck between costs that keep climbing and Plan Members whose expectations keep rising. But maybe “stuck” isn’t the right word.

Maybe this is the turning point. Sustainability can’t just mean containing costs anymore. It has to mean creating benefits that people actually use, that genuinely improve wellbeing, and that stand the test of time without eroding trust. 

That means rethinking the way resources are allocated, closing the communication gap, and being more honest and aware about where the pain points really are. It means finding funding models flexible enough to balance adequacy with affordability. And it means keeping a close eye on new trends — like dental demand and drugs — before they overwhelm the system. 

The collision between sustainability and wellbeing is real. But if Plan Sponsors can learn from it, the future of benefits could be stronger, not weaker. 

It’s time to sustain communication! 

To fix the issues of sustainability, the communication gap between Plan Members and Plan Sponsors must close. Read our other blog on communication to figure out best practices to ensure proper communication. 

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