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May 2023 eNews
Update: Introducing changes to our Diabetes Management Program
Beginning June 1, 2023, we are introducing additional standard drug plan controls as part of our Diabetes Management Program.
The controls will apply to GLP-1 agonists approved by Health Canada for the treatment of diabetes, such as: Adlyxine, Mounjaro, Ozempic, Rybelsus, Trulicity, and Victoza.
This change will help manage the impact of these high-cost diabetes medications for your clients while continuing to provide plan members with access to effective treatments to manage their disease.
Why are we introducing this change?
GLP-1 agonists are the highest cost diabetes drugs on the market. Current Diabetes Canada Clinical Practice Guidelines recommend that most Type 2 diabetics begin treatment with lower-cost and equally effective first-line therapies, such as Metformin.
Some GLP-1 agonists are also used “off-label”. In other words, they are often prescribed for conditions for which they have not been approved by Health Canada, such as weight loss.
These additional controls will help ensure that these drugs are used appropriately – only for the treatment of diabetes and only after other first-line treatments have been tried.
If a client wishes to provide coverage for drugs specifically approved by Health Canada for weight loss, we have coverage options available.
How will this program work?
Plan members who receive a new prescription for a GLP-1 agonist will need to try a first-line diabetic treatment before they are eligible for coverage of the GLP-1 agonist. If the plan member has previously tried first-line therapies and found them ineffective, they will be eligible for a GLP-1 agonist.
Plan members who are already taking a GLP-1 agonist to treat diabetes will continue to be eligible for coverage. Some claimants may need to provide confirmation of their diabetes diagnosis from their physician or pharmacist in order to maintain coverage. We will provide claimants ample time to confirm their diagnosis.
Questions?
If you have any questions about these additional standard controls or how they will impact your clients, please contact your Group Account Executive or myFlex Sales Manager.
Coming soon: Survey for plan administrators with recent disability claims
We are regularly enhancing our communication processes to help your clients with disability plans manage their workplace absences more effectively. Later this month, we will distribute a short survey to plan administrators who have submitted a disability claim in the past six months. The survey will ask recipients about their satisfaction with the frequency and detail of our disability management communications.
The email will come from GBClientFeedback@equitable.ca, and the survey will remain open until the end of the day on May 19, 2023. All responses will be confidential. Survey respondents will receive the option to provide their contact information so that we can follow up on feedback they have provided.
We plan to use the feedback to help ensure that we’re meeting your clients’ expectations and delivering industry-leading service.
In a previous issue of eNews, we published a list of the average dental fee increases for general practitioners based on the latest Provincial and Territorial Dental Association fee guides.
Since then, the Canadian Life and Health Insurance Association (CLHIA) has updated the 2023 dental fees for some provinces. Provinces with dental fee updates since our previous eNews are bolded and italicized. 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 2023.
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2024 Holiday hours
The Holiday season brings thoughts of gratitude, and there is no better time to express our thanks and sincere appreciation for your dedication and commitment to Equitable.
Thank you for your support this past year and for trusting Equitable with your Individual Insurance and Savings & Retirement business. Happy Holidays!
Client Care Centre Holiday Hours
Friday December 6, 2024 - CLOSED
Tuesday December 24, 2024 - 8:30 a.m. – 11:00 a.m. ET
Wednesday December 25, 2024 – CLOSED
Thursday December 26, 2024 – CLOSED
December 27, 30 and 31, 2024 - 8:30 a.m. – 7:30 p.m. ET
Wednesday January 1, 2025 - CLOSED
Savings & Retirement
All transaction requests to be handled same business day must be submitted in good order by:
● December 24, 2024, 11:00 a.m. ET
● December 31, 2024, 11:00 a.m. ET
FHSA applications to be considered for 2024 contribution year must be submitted in good order by:
● December 31, 2024, 11:59 p.m. ET
FHSA online banking deposit deadline for 2024 contribution receipt:
● December 24, 2024, 4:00 p.m. ET Note: Transaction requests submitted after 11:00 a.m. ET will be processed effective next business day
RRSP deposits to be considered for the 2024 tax year must be:
● Dated March 3, 2025, or before
● Must be submitted to Head Office in good order by March 7, 2025, by 4:00 p.m. ET
RRSP applications to be considered for 2024 contribution year must be submitted in good order by:
● March 3, 2025, 11:59 p.m. ET
RRSP B2B Loans:
● RRSP loan deposits must be received by March 14, 2025, by 4:00 p.m. ET
Note: Transactions submitted after these dates will not receive a 2024 contribution receipt
Individual Insurance
Underwriting
● Underwriting must receive all evidence and outstanding Underwriting requirements by December 9th at the latest. Underwriting will then be able to decision these cases by December 16th. This will give the New Business team December 13th – December 31st to issue and settle policies.
New Business
● New Business will continue to process all issue and settle requirements every business day until the last working day of the year – December 31st. New Business needs to receive ALL final settle documents in Good Order within our posted service standards. We are currently operating at a 3 business day turn around time.
Field Payroll
● Second Last Pay Period for 2024 – December 11, 2024 to December 17, 2024 (Transmission/Statement date December 18, 2024)
● Last Pay Period of 2024 – December 18, 2024 to December 31, 2024 (Transmission/Statement date January 2, 2025)
● First Pay of 2025 – January 1, 2025 to January 7, 2025 (Transmission/Statement date on January 8, 2025)
Daily Pay will run on business days.
Please note that all requirements must be received in Head Office by the above dates to guarantee settlement for year end.
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February 2026 eNews
In this issue:
Save time and add protection — log in to your Equitable account with a passkey*
New form offers a simpler way for clients to submit special claims*
2026 dental fee guide updates*
*Indicates content that will be shared with your clients.
Save time and add protection — log in to your Equitable account with a passkey
Passkeys offer an easier, faster way for you and your clients to log in to EquitableHealth.ca®. They also add an extra layer of account protection.
Easy set-up. Secure access.
If you haven’t created a passkey yet – now is a great time. You can create one on both your computer and mobile device.
When you set up a passkey on your mobile device, you’ll use biometrics –your face or fingerprint–to log in. This verifies your identity, so only you can access your account on your device.
Setting up a passkey on your computer is slightly different. You may have more options to verify your identity, such as biometrics, a personal identification number (PIN) or a password.
To learn more about passkeys, visit Equitable.ca/effortless.You hold the ‘key’ to further protecting your account
You’re the only one who can create passkeys. We can’t create them for you.
The set-up process is quick and easy. The videos below guide you through creating a passkey on your mobile device and computer.
If you use the same email address to log in to your accounts on EquitableHealth.ca, EquiNet® and Equitable Client Access®, you can use the same passkey. Equitable Client Access is our secure site for Individual Insurance and Individual Wealth clients.
New form offers a simpler way for clients to submit special claims
Equitable has simplified the special claim process for clients by introducing an interactive Special Claims Services form.
The new form, which replaces our previous online calculator, automatically calculates the fees and taxes based on province, so clients can clearly see the total of a special claim – and how much they need to pay.
What is a special claim?
A plan sponsor can submit a claim for Special Claims Services – sometimes referred to as Cost Plus – to pay for a plan member’s health and dental expenses that are either not included or not covered in full by their group benefits plan.
When submitting the claim, the plan sponsor also pays us for the cost of the expense, plus a service fee and taxes. Then, we reimburse the plan member or another designated payee.
Anything eligible under a health-care spending account (HCSA) is eligible under Special Claims Services. Our HCSA list of eligible expenses matches the Canada Revenue Agency’s list of eligible medical expenses that can be claimed on a tax return.
When a plan sponsor submits a special claim, there is no impact to the claims experience, pooling or taxes. Given that every situation is unique, however, the plan sponsor is responsible for consulting with an accountant on tax impacts and/or claim limitations that may apply.
For more information on Special Claims Services, check out this brochure or email SpecialClaimsServices@equitable.ca.
2026 dental fee guide updates
Several Canadian dental associations have published their 2026 fee guides. We use these guides to help set benefits reimbursement limits for dental procedures.
For your reference, here is the list of this year’s fee increases for general practitioners.
Source: Canadian Life and Health Insurance Association (CLHIA) 2026 Dental Fee Increase Guide
If you have any questions, please contact your Group Account Executive. - [pdf] Create A Household - Equitable GIF
- [pdf] A Unique Approach to Managing Disability
- [pdf] Underwriting cover letter template
- [pdf] Special Note PIP and Solutions
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Equitable Life Group Benefits Bulletin – March 2022
In this issue:
- CLHIA launches industry anti-fraud initiative*
- Provincial biosimilar update*
- Quebec decreasing insurance premium tax*
- Coming soon: A survey to understand how we can better serve your clients’ needs*
- Remind your clients’ plan members in BC, Manitoba and Saskatchewan to register for Pharmacare *
CLHIA launches industry anti-fraud initiative*
In February, the Canadian Life and Health Insurance Association (CLHIA) announced a new anti-fraud initiative that is using advanced artificial intelligence (AI) to further identify and reduce benefits fraud.
Equitable Life is excited to be a part of this important initiative. It will enhance our own fraud detection analytics by using AI to connect the dots across a huge pool of anonymized claims data. This will lead to more investigations and actions to mitigate the impact of fraud on your clients’ plans.
The initiative is being led by the CLHIA and member insurers and is supported by technology provider Shift Technologies. It will be further rolled-out and expanded over the next three years.
Benefits fraud affects more than just insurers. The costs of fraud are felt by employers and their employees as well. We are looking forward to being able to better identify and reduce benefits fraud.
Provincial biosimilar update*
BC expands its biosimilar initiative
BC Pharmacare recently announced it is adding two rapid-acting insulins to the list of drugs included in its ongoing initiative to switch patients to biosimilar versions of high-cost biologics. Patients taking Humalog or NovoRapid for Type 1 or Type 2 diabetes will be required to switch to a biosimilar version of the drugs by May 29, 2022 to maintain coverage under the public plan.
Biologics are drugs that are engineered using living organisms like yeast and bacteria. The first version of a biologic developed is also known as the “originator” biologic. Biosimilars are also biologics. They are highly similar to the originator biologic drugs they are based on, and Health Canada considers them to be equally safe and effective for approved conditions.
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 Humalog or NovoRapid for plan members in BC. Effective June 1, 2022, claimants currently taking Humalog or NovoRapid will be required to switch to a biosimilar version of the drugs to maintain coverage under their Equitable Life plan and their BC Pharmacare plan.
We will be communicating this change to plan administrators later this week. And we will be communicating with affected claimants in early April to allow ample time to change their prescription and avoid any interruptions in their treatment or their coverage.
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
Nova Scotia and Northwest Territories introduce biosimilar initiatives
The governments of Nova Scotia and the Northwest Territories each recently announced they are launching biosimilar initiatives to switch patients from certain originator biologic drugs to biosimilar versions of the drugs.
Patients in Nova Scotia using affected originator biologic drugs will have until February 2023 to switch to a biosimilar version of their medications in order to maintain coverage under the province’s public drug plans. Patients in the Northwest Territories will have until June 20, 2022, to switch.
Equitable Life® actively monitors and investigates all biosimilar policy changes and the ongoing evolution of biosimilar drugs entering Canada. We will keep you informed of any impact on private drug plans and how we are responding.
Quebec decreasing insurance premium tax*
The Quebec Government has announced that it plans to decrease its Insurance Premium Tax rates effective April 1, 2022. The premium tax rates for group life and accident and sickness insurance are expected to decrease from 3.48% to 3.3%. The new tax rates will be applied to premiums for the billing period beginning on or after April 1, 2022.
Coming soon: A survey to understand how we can better serve your clients’ needs*
We are committed to providing your clients and their plan members with industry-leading service. We’ve introduced several enhancements over the past year to make it easier to do business with us. And we’re continually looking for ways to improve.
In the coming weeks, we will conduct a survey of your clients to help us understand how we can better serve them. On March 28, we will send plan administrators an email with a link to the survey. The survey will remain open until the end of the day on April 11 and will take between five and 10 minutes to complete. Please encourage your clients to participate. Their feedback will be confidential, and their responses will help us improve our service and ensure we’re meeting their expectations. We may also follow up with plan administrators directly to address any concerns they’ve identified.
We know your clients’ time is valuable. So, each plan administrator who completes the survey will be entered into a random draw for a chance to win one of 25 prepaid gift cards for $25.
Remind your clients’ plan members in BC, Manitoba and Saskatchewan to register for Pharmacare*
If your clients have plan members in British Columbia, Manitoba or Saskatchewan, the provincial government offers a Pharmacare program to support prescription drug costs. Plan members in these provinces must register for their provincial Pharmacare program to maintain coverage under their Equitable Life drug plan.
Registration is easy! We will send two registration reminder messages directly to plan members’ pharmacists and post them on their Explanation of Benefits. We’ve also created a step-by-step guide that your clients can share with their plan members.
English version
French version
For more information about the provincial Pharmacare programs, including how plan members can register, please visit:
For British Columbia residents: https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents
For Manitoba residents: https://www.gov.mb.ca/health/pharmacare/apply.html
For Saskatchewan residents: https://www.saskatchewan.ca/residents/health/prescription-drug-plans-and-health-coverage/extended-benefits-and%20drug-plan/drug-cost-assistance#eligibility