Hormonal conditions may be driving disability claims disguised as mental health. iA’s Myriam Auclair explains how they’re testing that theory
Most group benefits plans have spent years building out coverage for physical and mental health, but hormonal health and metabolic conditions have largely sat outside that framework, treated as a footnote to menopause benefits or ignored altogether.
But one group insurer is attempting to change that with a new partnership that puts metabolic and hormonal care at the centre of its product strategy.
According to Myriam Auclair, product leader of group insurance at iA Financial Group, the recent partnership with Science & Humans gives iA’s plan members access to seven specialized programs covering reproductive health for women and men, fertility, pregnancy, perimenopause, menopause, andropause, and weight management.
She noted that each program costs a flat $540 for a 12-month care plan, paid by the member and reimbursable through health spending accounts or eligible for a CRA tax credit.
Auclair suggests that it’s a deliberate departure from the employer-funded, per-employee-per-month model that dominates virtual care. For her, that flexibility is the point.
"For some services, like the EAP, we know that the employer will pay for all of their employees because it’s the base mental health program. But talking about hormonal health or weight management is so specific to certain individuals," she said. "We knew that not all employers want to pay for everyone because there’s such specific needs."
Access to specialized care remains difficult
Last year, iA launched women's health and weight management initiatives that expanded drug coverage, paramedical benefits, and virtual health access. While the response was enthusiastic, Auclair acknowledged it exposed a deeper problem.
“People suggested it was difficult to access care,” she said. “Most of the feedback that we gather, even from our own employees at iA was that there were delays seeing specialized care. And most of the time, the delays were very long. Like many, many months.”
That access gap pushed iA to look beyond its existing provider network for specialized, ongoing clinical support but iA wanted something wider, particularly as they noticed the absence of men’s health programming. According to Auclair, Science & Humans offered coverage across reproductive health for both sexes, something that no other provider in the market could match. They also had a weight management program, which aligned with iA's existing product priorities. The fact that Science & Humans operated as a pan-Canadian, bilingual, and fully virtual platform made the fit practical as well as strategic, she said.
Hormonal health doesn’t fit traditional care
Yet, iA is rethinking the economics of virtual care, said Auclair, noting how the traditional model that’s employer-funded, per-employee-per-month, universal access, works for baseline services like telemedicine and EAP. But hormonal and metabolic health don't fit that mold. The needs are too specific, and not every employer is willing to absorb the cost for an entire workforce.
To that end, iA's proposed solution is a hybrid structure. For targeted programs like hormonal health, the insurer negotiates a preferential rate with a specialized provider, and the member pays directly. Claims reimbursement is then processed through their health spending account or other plan mechanisms.
According to Auclair, iA is already applying this logic elsewhere, including a separate arrangement with a sleep provider where members draw on paramedical psychology benefits to offset costs.
Inside the plan member experience
The member experience, Auclair said, is straightforward as plan members sign up through a co-branded landing page, pay by credit card, and submit the invoice through iA's digital claims process. Auclair said iA worked with its claims team to fast-track reimbursements, recognizing that $540 is a significant out-of-pocket cost.
But the clinical pathway is where the program diverges from standard virtual care, Auclair suggests.
"What is different with Science and Human compared to regular telemedicine, for example, is that the blood work will be super detailed. They will evaluate maybe 40 biomarkers, whereas if I were to consult telemedicine for perimenopause, maybe they look at two or three biomarkers. So sometimes they can miss some things," she said.
A second consultation interprets the results and builds a personalized care plan. From there, members receive three to four follow-up consultations over the year and unlimited messaging access to a care team - meaning treatment can be adjusted within weeks rather than waiting months for the next appointment.
According to Auclair, the cost sits entirely with the member. She affirmed there is no charge to the plan sponsor and members with a health spending account can claim full reimbursement at 100 per cent, not the partial coverage typical of other benefit categories.
Meanwhile, those without an HSA can still use the receipt as an eligible medical expense through the CRA at tax time. The goal is a model that can flex between employer-paid and member-paid depending on how niche the service is.
What’s next for hormonal health
The partnership launched quietly before the summer, and Auclair acknowledged it is too early to measure ROI. iA plans to increase visibility this fall, including a men's health initiative in the coming weeks.
But the bigger play may be on the disability side. Auclair said she is working with iA's case managers and rehabilitation specialists to explore how hormonal health programs could intercept claims that are being categorized as mental health related.
"There are some people who are on disability that we or they may think is mental health related, but most of the time, it may be hormone related," she said. "So we're actually exploring how we can leverage this partnership in disability. To make sure that we can help those people and get the right treatment for the right cause."
