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Equitable Life Group Benefits Bulletin – November 2021
In this issue:
- Deadline to opt out of New Brunswick biosimilar program*
- Web Reports Quick Reference Guide now available for plan administrators*
- Reminder: Review manual allocations for HCSAs and/or TSAs*
- Help your clients take advantage of our convenient digital options*
Reminder: Deadline to opt out of New Brunswick biosimilar program*
Earlier this year, we announced via eNews that on Feb. 1, 2022, we are ending coverage for some originator biologic drugs in New Brunswick in response to the province’s Biosimilar Initiative.* These changes will help protect your clients’ plans from additional drug costs while still providing access to equally safe and effective biosimilars.
Do my clients need to take any action?
No action is required if employers want to have the originator biologics excluded from their plan. Plan members taking these targeted originator biologics will be contacted directly to allow them ample time to transition to the biosimilar. Any cost savings associated with the change will be factored in at renewal.
All groups, except myFlex clients, who wish to opt out of this change and maintain coverage of these originator biologics for existing claimants in New Brunswick can submit a policy amendment. Amendments must be submitted no later than Nov. 30, 2021.
Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for New Brunswick plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.
Groups that opt out of this change are also opting out of any future changes to our New Brunswick biosimilar initiative. This means that their drug plans will continue to cover any additional originator biologics for which we subsequently end coverage as part of the biosimilar program.
Questions?
If you have a question that isn’t answered here, please contact your Equitable Life Group Account Executive or myFlex Sales Manager.
* The list of affected drugs or conditions is dynamic and may change.Web Reports Quick Reference Guide now available for plan administrators
A Web Reports Quick Reference Guide is now available for plan administrators on EquitableHealth.ca. This new guide offers a listing of our newest reports available on the plan administrator web. It also provides instructions for plan administrators outlining how to pull the report using the plan administrator portal.
The guide is available under the Quick Links section on both the advisor and plan administrator portals on EquitableHealth.ca.Reminder: Review manual allocations for HCSAs and/or TSAs*
If your client’s Health Care Spending Account (HCSA) and/or Taxable Spending Account (TSA) has manual allocations, they need to allocate these amounts to plan members each year. Please review all your plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year.
If your clients have Plan Administrator update access on EquitableHealth.ca, they can update these amounts online by doing the following:- Select “View certificate”
- Select “Health Care Spending Account” or “Taxable Spending Account”
- Select “Update Allocation” in Task Center
- Enter amount in “Revised Allocation Amount”
- Override Reason – “Plan Administrator Request”
- Select “Save”
- Select “Reports”
- Select “New”
- Select “Next”
- Select “HCSA” or “TSA Totals by Plan Member”
- Select “Next”
- Enter end date of “12/31/2020”
- Select “Next”
- Select “Finish”
- View “Report”
Help your clients take advantage of our convenient digital options*
We have several digital options available to make it easier for your clients to do business with us and for their plan members to access and use their benefits plan. Over 71% of plan administrators are managing their plan online and 78% of plan members are already using our digital tools.
For plan administrators:- Online Plan Member Enrolment tool – allows all groups to add new plan members without the need for paper forms
- Plan Administrator Portal (EquitableHealth.ca) – plan administrators can easily manage their plan anytime and anywhere
- Digital Welcome Kits – personalized welcome kits are delivered to plan members via email
- Easy automated payments – plan administrators can avoid missed payments by setting up pre-authorized debit or electronic funds transfer
- Plan Member Portal (EquitableHealth.ca) – plan members get secure, 24/7 access to their claims history, coverage details and health and wellness resources
- Electronic Claim Payments and Notifications – plan members can get claim updates sooner in their email inbox and payments right into their bank account
- EZClaim Mobile App – submitting claims from a mobile device is fast, easy and secure
- Digital Benefits Cards – plan members no longer have to dig through their wallet – they can download their benefits card on their mobile device
We’ve created a brochure and a video guide to help plan members access and use their digital resources. For further assistance, plan members can visit www.equitable.ca/go/digital. They can also contact our Web Services team at 1.800.265.4556 ext. 283 or groupbenefitsadmin@equitable.ca. -
Equitable Life Group Benefits Bulletin – February 2022
In this issue:
- Update: Alberta biosimilar coverage changes*
- Preferred Biosimilar Program*
- Responding to Quebec’s biosimilar policy*
- Dental fee guide updates*
- Reminder: Review manual allocations for HCSAs and/or TSAs*
- Mental health resources for plan members*
Update: Alberta biosimilar coverage changes*
In 2022, Alberta’s provincial drug plan is adding four originator biologics to its Biosimilar Initiative. It has ended or will end provincial coverage of these drugs for some or all conditions, as follows:
Four originator biologics added to Alberta Biosimilar Initiative- Lovenox: Jan. 10, 2022
- Humalog: Feb. 1, 2022
- NovoRapid: April 1, 2022
- Humira: May 1, 2022
Patients 18 and over who are using these drugs for the affected conditions will be required to switch to biosimilar versions of the drugs to maintain coverage under the province’s government drug plan.
How we are responding to protect our clients
To help prevent this change from resulting in additional costs for our clients’ drug plans while still providing plan members with access to safe and effective medications, we will no longer cover these originator biologic drugs for plan members in Alberta.
Effective May 1, 2022, claimants currently taking these drugs will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable Life plan.
This is a continuation of the Alberta biosimilar switch program we launched last March, when the province first introduced its Biosimilar Initiative.
Do my clients need to take any action?
No action is required by plan sponsors. Plan members taking these targeted originator biologics will be contacted directly to allow them ample time to transition to a biosimilar. Any cost savings associated with the change will be factored in at renewal.
Groups that opted out of the biologic coverage changes we made last March will automatically be opted out of these coverage changes, as well as any future changes to our Alberta biosimilar switch program. This means that their drug plans will continue to provide coverage to existing claimants for any originator biologics we stop covering as part of our biosimilar program.
Advisors with clients who wish to opt out of our Alberta biosimilar program, or who previously opted out and want to opt back in, should speak to their Group Account Executive or myFlex Sales Manager.
Communication to plan members
We will be communicating these coverage changes with affected claimants in early March to allow them ample time to change their prescriptions and avoid any interruptions in their treatment or their coverage. Thus far, the transition to biosimilars, has been smooth and continues to be successful.
What is the difference between biologics and biosimilars?
Biologics are drugs that are engineered using living organisms like yeast and bacteria. The first version of a biologic developed is known as the “originator” biologic. Biosimilars are also biologics. Biosimilars are highly similar to the drugs they are based on and Health Canada considers them to be equally safe and effective for approved conditions.
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.Preferred Biosimilar Program*
As part of our ongoing efforts to help ensure the sustainability of your clients’ drug plans, we continue to engage in strategic partnerships with pharmaceutical manufacturers.
We are pleased to announce a partnership to make Hyrimoz our preferred biosimilar for Humira. This partnership will generate additional savings for plan sponsors.
Plan members will still have the choice to use Humira biosimilars other than Hyrimoz. However, in the absence of alternative sources of reimbursement, this may increase their out-of-pocket amount.
The Preferred Biosimilar Program will take effect March 1, 2022 for all new claimants across Canada who start using a Humira biosimilar. It will take effect May 1 for existing claimants in Alberta who switch to a Humira biosimilar, to align with changes to the provincial plan.
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.Responding to Quebec’s biosimilar policy
Last year, the Quebec government announced it is phasing out coverage of biologic drugs. Beginning April 13, 2022, patients in Quebec using originator biologics will be required to switch to the corresponding biosimilar covered on the province’s public plan in order to maintain coverage.
The following populations are excepted from this new policy:- Pregnant women, who should be transitioned to biosimilars in the 12 months after childbirth.
- Pediatric patients, who should be transitioned to biosimilars in the 12 months after their 18th birthdays.
- Patients who have experienced two or more therapeutic failures while being treated with a biologic drug for the same chronic disease.
We are actively investigating the impact of this new policy on private drug plans in Quebec. We plan to implement further enhancements to our biosimilar programs in Quebec later this year to help prevent this change from resulting in additional costs for our clients’ drug plans. We will provide more details in the coming months.Dental fee guide updates
Each year, Provincial and Territorial Dental Associations publish fee guides. Equitable Life uses these guides to help determine the reimbursement limits for dental procedures. For your reference, below is the list of the average dental fee increases for general practitioners that will be used by Equitable Life for 2022.*
Dental fee guide increases over 2021*
*Data for all provinces and territories was not available at the time of publication. This chart will be updated on EquitableHealth.ca as more information becomes available.Province/Territory Average Fee Increase Alberta 3.9% British Columbia 7.35% Manitoba 5.79% New Brunswick 5.9% Newfoundland and Labrador 5% Nova Scotia 7.05% Northwest Territories 3% Nunavut 3.1% Ontario 4.75% Prince Edward Island 4.75% Quebec 5% Saskatchewan 5.99%
Reminder: Review manual allocations for HCSAs and/or TSAs*
If your client’s Health Care Spending Account (HCSA) and/or Taxable Spending Account (TSA) has manual allocations, they need to allocate these amounts to plan members each year. Please review all your plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year.
If your clients have Plan Administrator update access on EquitableHealth.ca, they can update these amounts online by doing the following:- Select “View certificate”
- Select “Health Care Spending Account” or “Taxable Spending Account”
- Select “Update Allocation” in Task Center
- Enter amount in “Revised Allocation Amount”
- Override Reason – “Plan Administrator Request”
- Select “Save”
- Select “Reports”
- Select “New”
- Select “Next”
- Select “HCSA” or “TSA Totals by Plan Member”
- Select “Next”
- Enter end date of “12/31/2020”
- Select “Next”
- Select “Finish”
- View “Report”
Mental health resources for plan members*
As the COVID-19 pandemic continues to evolve, many Canadians are experiencing increased levels of stress, anxiety, and depression. Through our partnership with Homewood Health®, all of our clients and their plan members have access to a number of health and wellness resources designed to provide guidance and support. These resources include a number of webinars which discuss various COVID-19 and mental health-related topics. The webinars are pre-recorded so plan members can stream them at their convenience.
Understanding the Impact of COVID-19 on Your Mental Health
English webinar
French webinar
COVID-19: Loneliness & Isolation Fatigue - Self-Care Strategies
English webinar
French webinar
COVID-19: Dealing with Seasonal Affective Disorder
English webinar
French webinar
Reducing Anxiety & Managing the Transition Back to the Classroom - for Teachers
English webinar
French webinar
COVID-19: Specialized Mental Health Support for Health Care Professionals
English webinar
French webinar
COVID-19: Supporting Children’s Mental Health
English webinar
French webinar
Additional resources, including articles, tools, videos and podcasts, are available at Homeweb.ca/Equitable. Please encourage your clients to share these resources with their plan members.
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Equitable Life Group Benefits Bulletin - October 2022
Introducing new Gender Affirmation Coverage for group benefits plans
Providing an inclusive benefits plan can play a critical role in fostering a workplace culture that welcomes diversity and helps employees thrive. While most provinces cover the cost of gender-affirming surgery, each person has unique needs. Some may require procedures that are not publicly covered.
That’s why we’re pleased to introduce a new coverage option for gender affirmation surgical procedures that are not covered by provincial health plans. Gender Affirmation Coverage helps plan sponsors to close the gap where provincial health coverage ends.Coverage details and eligibility
Gender Affirmation Coverage can be added to any Equitable Life plan with an in-force Extended Health Care plan. It provides coverage for gender-affirming procedures that are not covered by provincial health plans. This might include tracheal (Adam’s apple) shaving and voice surgery. It will also cover some additional procedures to further align the plan member’s features to the transitioned gender, such as facial bone reduction and cheek augmentation. This makes a wider variety of gender-affirming surgeries accessible to plan members and helps minimize their out-of-pocket costs.
Plan members are eligible for coverage with a diagnosis of gender dysphoria from a qualified health care professional.Offering a more inclusive benefits plan
The coverage provides one more way for your clients to offer more inclusive coverage and to offer holistic support to their plan members undergoing a gender transition. We have developed this coverage as a complement to our existing coverage options, including Health Care Spending Accounts (HCSAs), Taxable Spending Accounts (TSAs), Extended Health Care and drug coverage, and Employee and Family Assistance Programs, all of which can provide support to plan members undergoing gender affirmation.
We regularly review our products to ensure that they’re meeting your clients’ needs, and we’re committed to offering products that support diversity, equity and inclusion.
We also continue to review our forms, documents and processes to make them more inclusive. This includes reviewing our online plan member enrolment (OPME) tool to allow for more flexibility with the way plan members identify their gender.Gender affirmation and mental well-being
Gender affirmation procedures can lead to improved mental health outcomes for those with gender dysphoria, as most report an improvement in their quality of life following the procedures. Gender dysphoria may occur when a person’s assigned sex at birth does not match their identity, and people experiencing gender dysphoria typically report psychological and emotional distress, including symptoms of depression or anxiety. By offering coverage where provincial health coverage ends, your clients can support plan members as they seek procedures that align their body presentation with their self-identified gender.
Advantages at a glance
Advantages for plan members include:- Reimbursement for some procedures and expenses, leading to fewer out-of-pocket costs
- May experience improved mental health outcomes after surgery
- A benefits plan that promotes a culture of diversity, equity and inclusion, which may build employee loyalty
- Support for plan member mental health to help those with gender dysphoria thrive
The Benefits Canada 2022 Health Care Survey results are in!
Equitable Life is proud to be a Platinum sponsor for The Benefits Canada 2022 Health Care Survey, Canada’s leading survey on workplace benefits plans. This year’s survey report highlights many fascinating insights across a wide variety of benefits topics, including:- A focus on mental health for both plan sponsors and plan members
- The repercussions of the "shadow" pandemic due to health care delays
- Trends in plan members' overall perceptions of their health benefits plans
- The types of benefits getting more attention from plan members
- The role of remote work in plan member satisfaction
We’re committed to helping you and your clients navigate the evolving landscape of employee benefits in Canada by contributing to this vibrant industry community. To read the full report, visit Benefits Canada.
HCSA and TSA manual allocation reminder
If your clients’ Health Care Spending Account (HCSA) and/or Taxable Spending Account (TSA) have manual allocations, they need to allocate these amounts to plan members each year. Clients should review their plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year. Your clients may also order HCSA and TSA forfeiture reports on EquitableHealth.ca.
If your clients have Plan Administrator update access on EquitableHealth.ca, they can update these amounts online by doing the following:- Select View certificate
- Select Health Care Spending Account or Taxable Spending Account
- Select Update Allocation in Task Center
- Enter amount in Revised Allocation Amount
- Override Reason – Plan Administrator Request
- Select Save
- Select Reports
- Select New
- Select Next
- Select HCSA or TSA Totals by Plan Member
- Select Next
- Enter end date of 12/31/2022
- Select Next
- Select Finish
- View Report
- [pdf] Supply Order Form (Life and Health)