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COVID-19 Group Benefits FAQ

The situation surrounding COVID-19 is very fluid and continues to evolve rapidly and we will continue to provide timely updates to this FAQ as things change. Please continue to visit this site for updates.

We remain ready and committed to support you, your clients and their plan members at this challenging time.

As the situation surrounding COVID-19 continues to develop, we know you will have questions about what it means for your clients and their plan members. So, it’s important that you have the most up-to-date information.

Below are responses to some of the most common questions we have received.

If you or your clients have questions or concerns that aren’t addressed below, your Group Account Executive and myFlex Sales Manager are well equipped to navigate Equitable Life’s experts and to resolve difficulties. Our commitment to you and your clients is to respond quickly, and to be flexible where we can, tailoring solutions to specific needs.

These are extraordinary times and history is in the making. Rest assured that Equitable Life is unwavering in our support, and we will be here to help you when it matters most.

Business Continuity

Travel Assist

Disability

Cost Relief Options

Staffing Changes and Layoffs

The Canada Emergency Wage Subsidy

Other government relief programs for business

Premium Relief for Health and Dental Benefits

Infectious Disease Emergency Leave

Other


Business Continuity


Does Equitable Life have a business continuity and pandemic plan?

We have a robust and well-tested business continuity plan in place and have taken the necessary steps to maintain the high level of service you have come to expect from us. Our business is near 100% digital, so the vast majority of our employees are now working remotely from home and are fully functional. Our Customer Care Centre remains open to support plan members and can be reached at 1.800.265.4556. And our Client Relationship Specialists are available for Plan Administrator questions and support.


Does Equitable Life continue to meet or exceed capital requirements for the Office of the Superintendent of Financial Institutions (OSFI) or other applicable provincial regulators? And can it do so if the pandemic continues for a longer period of time?

Yes. Our Life Insurance Capital Adequacy Test (LICAT) ratio at the end of December was one of the strongest in the industry. Based on recent estimates following recent market volatility, we continue to far exceed OSFI capital requirements.


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Travel Assist


My client has an employee who is currently outside the country and has symptoms consistent with COVID-19 or has tested positive for COVID-19. What should they do?

If a plan member is currently travelling abroad and is experiencing symptoms or is hospitalized with suspicion of the coronavirus, they should contact Allianz at the numbers listed below for assistance and to confirm their coverage.

  • Toll-free Canada/USA: 1.800.321.9998
  • Global call collect: 519.742.3287
  • Allianz Global Assistance ID #9089


Are plan members who travel internationally in 2021 still eligible for Travel Assist coverage?

Effective Feb. 28, 2022, the Government of Canada will lift the “avoid non-essential’ travel advisory it put in place last December due to the spread of the Omicron variant of COVID-19. That means most countries will return to their pre-COVID status.
 
Plan members with Travel Assist on their plan will once again be covered for out-of-country medical assistance for most countries. They are not covered if they travel to destinations with the following advisories in place:

  • “Avoid all travel”; or
  • “Avoid non-essential travel”. If a plan member’s travel is deemed essential, they should contact Allianz to confirm eligibility. 

Since the COVID-19 situation can evolve quickly in any given country, plan members should check the Government of Canada’s Travel Advice and Advisory page before departing. Effective Feb. 28, the Canadian government is easing the on-arrival testing for fully-vaccinated travellers.
 
Plan members travelling to another country should also consult that country’s travel restrictions and guidelines before departure to avoid any disruptions or delays. Travelers could be denied entry to another country even though their travel may be considered essential, or they may be forced to self-isolate when they arrive at their destination.
 
As well, border closures or flight cancellations could leave travellers stranded, and their Travel Assist coverage could expire while they are still abroad. We will not extend trip durations, even if a plan member is unable to return home before their coverage expires. If a plan member tests positive for COVID-19 and is forced to quarantine, Travel Assist does not cover expenses for accommodations or meals, unless they are associated with a medical emergency.
 
As per Canada’s COVID-19 health guidelines, we continue to strongly urge plan members to take personal protective measures when travelling, such as wearing a mask, avoiding crowded places, washing their hands and maintaining physical distancing, where possible.
 
Please note: Allianz is currently experiencing significantly higher call volumes than usual. This is resulting in longer wait times.
 

My client has employees who need to travel across the border as an essential part of their job (i.e. commercial truck drivers). Will they continue to be covered under Travel Assist?

Yes, these employees will continue to be covered if they have Travel Assist on their plan.


My client has a plan member who is an essential service person and who travels across the border as part of their job. Will their dependents be covered under Travel Assist if they travel with the plan member?

Yes. Dependents who are covered under the plan would continue to be covered when travelling with someone who is an essential service person.


If an employee travelled prior to the travel restrictions and is unable to return to the country for whatever reason (flights cancelled, etc.) will they still be covered if the travel period expires (i.e. they have 30 days and are now nearing that mark and no way to get home). Does the travel insurance automatically extend?

Our expectation is that plan members who were caught out of the country due to COVID-19 will have returned to Canada by this point in time. If not, we continue to urge your clients to advise them to return to Canada as soon as it is possible to do so.

If your client has a plan member who continues to be out of the country, we ask that you reach out to us immediately so that we can validate the circumstances of the situation and determine whether or not day limit extensions continue to be applicable.


Is COVID-19 considered a pre-existing medical condition for the purpose of Travel Assist? If so, if a plan member has symptoms prior to departure, would they be ineligible for Travel Assist coverage while out of the province/country?

Yes. If a plan member has symptoms related to COVID-19 or is tested positive for COVID-19 prior to departure, they are not eligible for Out of Country coverage, including Travel Assist.


If someone travels interprovincially, from Ontario to BC for example, and the travel is non-essential, are inter-provincial guidelines to cover medical expenses still in place?

Inter-provincial guidelines to cover medical expenses for people visiting from other provinces, for both COVID-19 and non-COVID-19 issues, continue to be in place. However, some provinces have restrictions in place for the entry of non-essential travelers. Before travelling to another province, plan members should check the restrictions for their destination province to confirm whether they will be allowed to enter the province


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Disability


I have an employee who is self-isolating or in quarantine. Are they eligible for short-term disability?

Yes. Plan members who have tested positive forCOVID-19 are eligible for coverage if they are unable to work from home. Claims will be assessed according to the terms of their plan, and the appropriate waiting period applied.

Since access to COVID-19 PCR testing is restricted in some provinces, what proof does Equitable Life require from plan members making a COVID-19-related short-term disability (STD) claim? How do they submit the claim?

Effective Jan. 1, 2022, a positive COVID-19 PCR test is not required for a plan member to submit a COVID-19-related short-term disability (STD) claim.

Plan members who are experiencing symptoms of COVID-19 or who have tested positive for COVID-19 (either with a PCR test or with an at-home rapid test) and are unable to work from home should complete the Short Term Disability Plan Member COVID-19 Claim Form (#421A). 

They should indicate the date of the onset of symptoms or the date of their positive test result. Where applicable, they should also indicate the date they have been cleared by public health to end their self-isolation. The form includes an attestation that the information they have provided is accurate.

The employer needs to complete the Short Term Disability Employer COVID-19 Claim Form (#421B). They should indicate the expected return-to-work date according to their provincial health guidelines, or using the date provided by a public health official.

How long will a plan member receive STD benefits for a COVID-19-related claim? Does the standard STD waiting period apply to COVID-19-related claims?

To support plan members during the initial stages of the pandemic, we waived the short term disability (STD) waiting period if a plan member’s absence was due to symptoms or a diagnosis of COVID-19.  Now that COVID-19 has become the “new normal,” we are returning to our standard practices and treating the virus as we would any other illness.
 
Effective Jan. 1, 2022, standard waiting periods will apply for COVID-related STD claims, according to the terms of the Group policy. This ensures that all plan members submitting a STD claim are treated fairly, no matter what the cause of the claim.
 
Eligible plan members will receive STD benefits up to a maximum of 10 days from the date of the onset of symptoms or a positive COVID-19 test result, minus the waiting period.
 
For example, if the plan has a five-day waiting period, and the plan member returns to work nine days after a positive test result, they would be eligible for four days of benefits payments.
 
If the claimant is still unwell after 10 days, then the standard Short Term Disability Claim Form (#421) needs to be completed.  
 
If a plan member is admitted to hospital, benefits will be paid following the waiting period applicable to hospital claims. 


My client has an employee who is quarantined with no symptoms or positive COVID-19 test, and they were directed to apply for Employment Insurance (EI). What happens if they begin to exhibit symptoms and/or test positive for COVID-19 while collecting EI benefits? Would Equitable Life pay disability benefits retroactively?

Short-term disability benefits are payable from the start of symptoms or the date of the positive COVID-19 test, whichever is earlier. As such, we will not pay retroactive benefits for the full period of the quarantine because the individual had no symptoms for a portion of the period.

My client has an employee who has no symptoms consistent with COVID-19 but is in self-quarantine, either because they have:

  • recently returned from travel,

  • been instructed to do so by a health professional (including because they are immuno-compromised),

  • been instructed to do so by their employer

  • come in contact with someone who is infected with COVID-19.


Are they eligible for short-term disability?

No. Plan members who have no symptoms consistent with COVID-19 are not eligible for short-term disability. These plan members should inquire with their employer about options for working from home, if appropriate, or consider applying for Employment Insurance (EI) benefits.
 
They also may be eligible for the Canada Recovery Sickness Benefit, which has been extended to May 2022. As well, the federal government has several other COVID-19 relief programs that may be of help.
 

Short Term Disability (STD) is an experience-rated benefit uniquely impacted by COVID-19. What will Equitable Life’s renewal approach be for Short Term Disability for the coming year?

The objective of any renewal is to establish rates that are adequate to cover expected future claims and expenses. Accordingly, we only use experience for rate setting purposes to the extent that we believe it reasonably forecasts future expected claims. The Underwriting team may exclude claims that they believe are not a good measure of future claims or make an adjustment to the credibility level of a case, given unusual circumstances. Whether an STD claim is COVID-19-related will be considered as part of this process.


The federal government has introduced three new benefits: the Canada Recovery Benefit (CRB), the Canada Recovery Sickness Benefit (CRSB), and the Canada Recovery Caregiving Benefit (CRCB). What impact, if any, will these benefits have on short-term disability (STD) claims?

These new federal benefits will have no impact on STD claims or benefits. If an employee has tested positive for COVID-19 or has symptoms consistent with COVID-19 and are unable to work from home, they would submit a claim to Equitable Life first. If we determine the employee is not eligible for disability benefits, then they could apply for the federal government’s recovery benefits.

If an employee is off work because they are a caregiver or have been laid off due to COVID, they would not qualify for disability benefits and can apply for the federal government’s recovery benefits.


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Cost Relief Options


My client’s business is facing financial hardship as a result of the COVID-19 pandemic and I need to cut costs. What are their options?

The federal government recently implemented The Canada Emergency Wage Subsidy which may impact the merits of the solutions below.

An employer has options when they are facing financial hardship and considering layoffs due to COVID-19. We’re happy to work with each employer to understand the options that suit their specific situation best.

1. Cut back selected benefits

Traditional plans: An employer can choose to continue to provide only selected benefits for up to 120 days. Any combination of Life, Short Term Disability, Long Term Disability, Health and/or Dental benefits is available for consideration. In these situations, premiums would continue to be paid for the benefits that remain in-force and claims can be submitted for reimbursement for those in-force benefits.

myFlex Benefits plans: An employer can choose to continue to provide only selected benefit coverage for an initial period of up to 120 days. We require the continuation of Life and Health benefits in order to maintain the plan, but the employer can temporarily terminate Dental. In these situations, premiums would continue to be paid for the benefits that remain in-force and claims can be submitted for reimbursement for those in-force benefits.

If an employer chooses to terminate Short Term Disability and/or Long Term Disability benefits, it is important to note the potential impacts to plan members:

Termination of STD or LTD: In the event that STD and/or LTD are terminated as part of a layoff, plan members would not be eligible to claim for any disability which started during the lay off period. Once the employee has been re-called to active work, their disability coverage is re-instated and then the individual can submit a claim, subject to the pre-existing provisions listed below.

In situations where the LTD benefit was terminated and the gap in coverage exceeds 12 months, the member is considered a new employee and their pre-existing condition period would re-set. It would begin after they satisfy the waiting period and a new effective date of coverage is established. In situations where the LTD benefit was terminated and the gap in coverage is less than 12 months, the pre-existing condition period does not reset.

Continuation of STD or LTD: In the event that STD and/or LTD remain in-force, a plan member who becomes disabled during the layoff period would be eligible to submit a claim for a disability benefit which started while they were on lay off. The date of disability would be deemed to be the date they were disabled.  However, benefits would be payable on the later of their recall date or the end of the elimination period.

2.For clients who need to reduce hours of work and/or salaries

In situations where an employer is temporarily reducing hours of work and therefore salaries for their employees, they have the following options:

  • Continue reporting on pre-reduced hours of work (for hourly employees) and salaries (for salaried employees). In this situation, premiums would remain at the pre-reduction level and, in the event of a claim, we would use the volume that has driven premium payment as part of our claim calculation.
  • Report the reduction in hours of work (for hourly employees) and reduction in salary (for salaried employees). When this occurs, bills and premiums would be based on the lower volumes of coverage. In the event of a claim, we would use the volume that has driven premium payment as part of our claim calculation.

It is crucial that an employer treat all employees in a consistent manner.

3.For clients who need to lay off employees

In situations where an employer has no choice but to implement layoffs, they are able to continue paying premiums and offering selected benefits (see Option #1 above) or to put benefits on hold for up to 120 days (see Option #4 below).

Before making layoffs, we recommend that clients speak to legal counsel. Employment lawyers have been warning that the law does not actually permit short-term layoffs in all circumstances.

4.For clients who need to temporarily put benefits on hold

While this is not an ideal situation, we do understand that an employer may not have a choice but to temporarily put a hold on their employee benefits until their company is back up and running. In this situation, we will maintain plan details and employee details on our system. At the employer’s request for amendment, we can quickly turn the program back on when their company reopens, and employees have returned to work.

5.For clients who need to terminate Group Benefits with Equitable Life

While this represents the worst-case long-term scenario for an employer and their employees, we understand that there will be situations where this does need to happen. When it does, benefits will remain in place up to the point where premiums have been paid. 

If at any point in the future, the employer wants to reopen benefits for their employees, they only have to reach out to their Advisor and our Group Account Executive to get the conversation started. We have procedures in place that would allow us to re-implement quickly and efficiently, though rates may have changed, and standard enrollment procedures for new employees would be required.


Can my client suspend their Health Care Spending Account (HCSA) claims?

Yes. A plan sponsor can choose to suspend HCSA claim payments at any point. Once the HCSA is turned back on, it will be imperative to ensure that employees are being treated consistently with respect to their allocations.

I have a client who pays premiums via pre-authorized debit (PAD) and who has made changes to their benefit plan to reduce costs. Do they need to take any action to avoid payment being automatically withdrawn on the usual date?

​Yes. Here are the steps they need to take:

  • At least five business days in advance of the PAD date, they need to request in writing that we deactivate PAD. Notification can be sent via email as long as the email is from a company address and is from a person of authority at the company.
  • They will be responsible for paying their premium via cheque or online bill payment. If payment is not received within 60 days of the due date, we will follow the normal process for suspension or termination.
  • When they decide to reinstate the PAD, they will need to provide us written direction to do so. Until that time, they will need to pay via cheque or online bill payment.


I have a client who has made changes to their benefit plan to reduce costs, but their payment has already been automatically withdrawn from their account via pre-authorized debit (PAD). What are their options to have their payment returned to them?

The default solution is that any overpayment of premium would be credited to their account. The amount of their next PAD withdrawal would be automatically reduced. No action by the plan sponsor is needed in this case.


I have a client who wants to temporarily put their benefits on hold, but they aren’t sure whether they need to do so for the full 120 days permitted. Does Equitable Life need to know the exact number of days before proceeding?

No. We will support the client as soon as they are ready to turn their plan back on.

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Staffing Changes and Layoffs


My client would like to continue benefits that require employee contributions, but they have no way of collecting the premium during the temporary layoff. What are their options if they want to pay all the premiums?

For Life, Health and Dental, there are no issues – the employer can pay all premiums if they choose. For non-taxable disability benefits, the employer can pay the premiums during the leave, and charge them to the employee when they return to work. Other options should be discussed with their Tax Advisor or Accountant. The employer may also terminate disability during the leave.


My client needs to decrease the number of lives for a short period of time. What is the minimum?

Our minimum is three full-time permanent lives in order to maintain benefits. Please discuss with your Group Account Executive or myFlex Sales Manager when other circumstances occur.


In-light of the COVID-19 situation, what is the lowest minimum hours per week Equitable Life will allow to be eligible for coverage?

If a full-time employee was eligible and enrolled in the plan prior to the COVID-19 situation, we will temporarily allow the employee to maintain coverage regardless of the number of hours they are working. However, employees that were not eligible prior to the COVID-19 situation, because they did not meet the minimum number of hours, will not be eligible to join the plan. We are not opening up eligibility for part-time employees to obtain coverage because we are relaxing the minimum number of hours for full-time employees impacted by COVID-19.


How long is the temporary allowance for the minimum number of hours in place?

Flexibility in our minimum number of hours will be on-going in order to support those customers who require it.


My client is reducing their employees’ hours due to COVID-19. Do they have to report these changes?

Employers who are reducing their employees’ hours of work (and therefore salaries) due to COVID-19 have the following options:

  • Continue reporting on pre-reduced hours of work (for hourly employees) and salaries (for salaried employees). In this situation, premiums would remain at the pre-reduction level and, in the event of a claim, we would use the volume of coverage on which the premium payment is based as part of our claim calculation.
  • Report the reduction in hours of work (for hourly employees) and salary (for salaried employees). When this occurs, bills and premiums would be based on the lower volumes of coverage. In the event of a claim, we would use the volume that has driven premium payment as part of our claim calculation.

It is crucial that an employer treat all employees in a consistent manner.

If the revised number of hours worked on a regularly scheduled basis is 15 hours or more per week, an exception request is not required during the COVID-19 situation. We do need to be advised, via email to our service team, of plan member level changes to ensure that our processes and eligibility are lined up at the customer level.


If an employee is laid off due to COVID-19 while they are still in the waiting period, will we consider their lay-off time as time served towards the waiting period?

Yes. During COVID-19, we consider an employee’s lay-off time as time served towards the waiting period.


Can my client require employees to pay 100% of the premiums during a temporary layoff?

Existing cost sharing arrangements should continue during a layoff. In the event of a layoff or leave, we recommend that employers encourage members to remain in the plan and maintain their coverage. We also recommend that they treat all employees consistently.

If an employee chooses not to continue an employee paid benefit, they must be reinstated by the employer within the first 31 days of their return to work. Otherwise, they will be considered a late applicant and will be subject to evidence of insurability.

If the plan member becomes disabled during the layoff and has maintained their disability benefits, they are eligible to submit a claim on the first day that they would have returned to work. If they do not maintain their disability benefits, they will not be eligible to submit a claim.


My client is laying off employees and continuing all benefits during the layoff. But some plan members are refusing to take them because they cannot afford the premiums. What are the plan members’ options?

If a plan member refuses continuation of coverage for employee-paid benefits, they can rejoin the plan within 31 days of their return-to-work date. The earliest date available to rejoin the plan is the date that they returned to work on a permanent basis. They must be actively at work for at least one day in order to rejoin the plan.

In these situations, it is important that the employer treats everyone consistently and makes plan members aware of the impacts if coverage is not maintained.

If a plan member does not continue coverage and becomes disabled while they are laid off, they would not be eligible to submit a claim for that disability at any point in the future.

If a plan member does continue coverage and becomes disabled while they are laid off, they are eligible to submit a claim for that disability, and the date of disability will be deemed to be the date that they were scheduled to return to work.


What is the maximum amount of time my client can lay off their employees but still reinstate their plan without requiring evidence of insurability?

Whether or not an employer maintains their benefits and continues paying premiums during the layoff period, the maximum time after which the plan can be reinstated without evidence of insurability will be as stipulated in the contract, or the period that was agreed upon at the time they notified us of the layoff. Employers are required to advise us of any COVID-19-related layoffs.


If an employee is laid off, chooses not to continue with benefits and then is rehired within 120 days, are there any pre-existing conditions relating to health and dental?

No. There is no pre-existing clause for health and dental coverage.However, if the employee does not re-apply for coverage within 31 days of their rehire date,evidence of insurability will be required and coverage may be declined.


What options are available to plan members whose coverage is temporarily terminated?

When a plan member’s coverage is terminated, we will reach out to them via email (or letter if we do not have their email address on file) to let them know about Coverage2go™, personal health and dental coverage that is affordable, reliable and works like their previous group benefits plan. A conversion option is also made available with no medical questions if they wish to purchase an individual life insurance product.


If the employer extends employee-paid Basic Life Insurance during a COVID-19-driven layoff, but the employee declines the continuation of the benefit, does the employee have the ability to convert the life Insurance to an individual product?

Yes.


How are benefit amounts being calculated if someone becomes disabled during the current pandemic and:

  • Is receiving a wage subsidy but is not currently actively at work,

  • Is on payroll but not actually working,

  • Is temporarily job sharing,

  • Has taken a temporary wage reduction, or

  • Has reduced their work week to 80% or less? 

Our understanding is that benefit volumes would remain unchanged and any disability claim would be calculated on the pre-COVID-19 amounts, no matter what the actual work situation. Can you please confirm?

Disability benefits are paid according to the earnings that employers are insuring. If an employer reduces hours and salary/wages for employees but has chosen to remit premiums based on their pre-COVID-19 earnings, then their disability benefits will be based on their pre-COVID-19 earnings. Similarly, if an employer has chosen to reduce hours and salary/wages for employees and is remitting premiums based on the lower amount, the disability benefits will be based on the lower amounts.

In terms of hours worked: If a full-time employee was eligible and enrolled in the plan prior to the COVID-19 situation, we will temporarily allow the employee to maintain coverage regardless of the number of hours they are working. However, employees that were not eligible prior to the COVID-19 situation, because they did not meet the minimum number of hours, will not be eligible to join the plan. We are not opening up eligibility for part-time employees to obtain coverage; we are only relaxing the minimum number of hours for full-time employees impacted by COVID-19.


I have a client whose plan member can’t afford the premiums for both themselves and their family. Can employees temporarily reduce their health and dental coverage from Family to Single to save money? If so, would they be able to switch back to Family coverage later without providing medical evidence for their dependents?

A plan member can shift from Family to Single coverage. However, without a defined life event (such as a marriage or the birth of a child), shifting back to Family coverage would require evidence of insurability for all dependents.


I have a client who has laid off some of their employees, effective March 16th, and has chosen to remove the LTD coverage during the lay-off. Effective April 6th, some of the employees began receiving the 75% wage subsidy but still had not returned to work, while others were still on a temporary lay-off without the wage subsidy. Can the LTD coverage be re-instated effective April 6th for the employees receiving the wage subsidy?

Yes, we can re-instate the coverage effective April 6th. Backdated premiums will be required.


I have a client who is raising salaries effective June 1 as part of their annual COLA increase. They have laid off some employees until June 21st due to COVID-19 but have extended benefits during the lay-off. Is a plan member on lay-off due to COVID-19 eligible for coverage based on the salary increase?

No. If salary-related benefits have continued during the layoff, salary increases are not applicable until the plan members have returned to work.


Even as restrictions start to be rolled back, many businesses remain unable to open and/or can only do so in a very limited fashion. What is Equitable Life’s position on clients who are nearing the end of the term of the layoff provision in their policies and who want to extend coverage to their employees potentially until the end of the current pandemic.

We can confirm that layoff extensions driven by COVID-19 continue to be supported. If you have a customer-specific situation that should be discussed, please reach out to your Underwriting team for case level support and clarity.


What impact will changes in participation due to COVID-19 have on renewals?
 

Given each group’s circumstances are different, the impact of COVID-19-based participation changes on renewals will be different from case to case. In each case, the objective of the renewal is to establish rates that are adequate to support the people we believe will be on the plan over the coming renewal period.
 
To forecast appropriate rates for experience-based benefits, the Underwriter will review:

  • Month-by-month changes in participation;

  • The anticipated layoff period without benefits; and

  • Any special circumstances they have discussed with the advisor, GAE or mSM.

For pooled benefits, such as Life and Long Term Disability, our standard rating will apply.
 
Ongoing communication between the advisor, GAE or mSM, and our Underwriting team will help us understand each group’s unique situation and forecast appropriate rates.


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The Canada Emergency Wage Subsidy


What is The Canada Emergency Wage Subsidy

The federal government has implemented The Canada Emergency Wage Subsidy. For eligible employers, it covers 75% of an employee’s wages – up to $847 per week -  for up to 12 weeks, retroactive to March 15, 2020.
 
The Subsidy is designed to provide employees with a source of income by enabling employers to re-hire workers previously laid off, and to keep those who are already on payroll. It was created with the expectation that employers will use the subsidy in a manner that supports the health and well-being of their employees


What businesses are eligible for the Subsidy

Employers of all sizes who have suffered a drop in gross revenues of at least 15% in March, and 30% in April or May are eligible for the subsidy. Eligible employers include: Individuals,
  • taxable corporations, and
  • partnerships consisting of eligible employers, non‑profit organizations and registered charities.

 
Public bodies are not eligible for this Subsidy.


How does the Subsidy work?

The subsidy amount for a given employee on eligible remuneration paid for the period between March 15 and June 6, 2020 is the greater of:

  • 75% of the amount of remuneration paid, up to a maximum benefit of $847 per week; and
  • the amount of remuneration paid, up to a maximum benefit of $847 per week or 75% of the employee's pre-crisis weekly remuneration, whichever is less.

There is no overall limit on the subsidy amount that an eligible employer may claim.
 
Employers are expected to make their best effort to top-up employees' salaries to bring them to pre-crisis levels.


How long is the Subsidy available?

The program will be in place for a 12-week period, from March 15 to June 6, 2020.


How can an employer apply for the Canada Emergency Wage Subsidy?

Eligible employers will be able to apply for the CEWS through the Canada Revenue Agency's My Business Account portal. Employers will need to keep records demonstrating their reduction in arm's-length revenues and remuneration paid to employees. More details about the application process will be made available shortly.


What if I don’t qualify for the Subsidy?

Organizations that don’t qualify for the Canada Emergency Wage Subsidy may continue to qualify for the previously announced wage subsidy of 10% of remuneration paid from March 18 to before June 20, up to a maximum subsidy of $1,375 per employee and $25,000 per employer.


What does it mean for my benefits plan?

A group benefits plan is critical to supporting employee health during this unprecedented time. The Canada Emergency Wage Subsidy can help ensure employers have the financial ability to continue coverage for their employees.


Where can I get more information about the Subsidy?

For more details about the program please see the Government of Canada website.

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Other government relief programs for business


What other government programs are available to businesses who are struggling during the COVID-19 crisis and want to help their employees?

Effective March 15, 2020, the federal government has extended the maximum duration of its Work-Sharing program from 38 weeks to 76 weeks for employers affected by COVID-19.

As well, employers can apply for a Supplementary Unemployment Benefit Plan (SUBP).


What is the Work-Sharing program?

The Work-Sharing (WS) Program helps employers and employees avoid layoffs when there is a temporary decrease in business activity beyond the control of the employer. The program provides Employment Insurance (EI) benefits to eligible employees who agree to reduce their normal working hours and share the available work while their employer recovers.


How does the Work-Sharing program work?

Work-Sharing is an agreement between employers, employees and the Government of Canada.

All members of a Work-Sharing unit (a group of employees with similar job duties) agree to reduce their hours of work by the same percentage and to share the available work over a specific period of time. A Work-Sharing unit must reduce its hours of work by at least 10% to 60%.


Who is eligible for the Work-Sharing Program?

To be eligible for a Work Sharing agreement, a business must:

  • be a year-round business in Canada for at least one year,
  • be a private business or a publicly held company, or
  • have at least two employees in the WS unit.

Eligibility was also extended to:

  • Government Business Enterprises (GBEs), and
  • Not-for-profit employers experiencing a shortage of work due to a reduction of business activity and/or a reduction in revenue levels due to COVID-19

To be eligible for Work-Sharing, employees must:

  • be year-round, permanent, full-time or part-time employees needed to carry out the day-to-day functions of the business,
  • be eligible to receive EI benefits, and
  • agree to reduce their normal working hours by the same percentage and to share the available work.

Eligibility was also extended to:

  • employees considered essential to the recovery and viability of the business can now be eligible to participate in Work-Sharing (such as technical employees engaged in product development, outside sales agents, marketing agents, etc.)


How can my client apply to the Work-Sharing Program?

To apply for the Work-Sharing program, employers must submit:

Employers are requested to submit their applications 10 calendar days prior to the requested start date.


Where can I get more information about the Work-Sharing program?

For more details about the program please see the Government of Canada website.
 


What is a Supplementary Unemployment Benefit Plan?

A supplementary unemployment benefit plan (SUBP) is a plan established by an employer or group of participating employers to top up employees' employment insurance (EI) benefits during a period of unemployment due to a temporary or indefinite layoff for:

  • health-related benefits
  • maternity, parental, compassionate care, family caregiver leave
  • sickness, accident, or disability
  • temporary stoppage of work training


How does a SUBP work?

Employers can provide employees with a top-up of their EI benefits based on a percentage of regular weekly income or set at a fixed weekly amount. Employers can also choose the duration for which benefits under the SUB plan will be available.

Before paying SUBs to their employees, employers must verify that the employees are in fact receiving employment insurance benefits. And an employer’s SUB plan cannot provide employees with more than 95% of their normal weekly earnings when combined with their EI benefits.

An employer will need to register their SUB plan with Service Canada and the SUBP must be approved by before it comes into effect. Once approved, the plan will be effective as of the date of the application.

Employers are responsible for financing their SUBPs.


Where can I get more information about the SUBP?

For more details about the program please see the Government of Canada website.


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Premium Relief for Health and Dental Benefits


Is Equitable offering premium relief for dental and health benefits given that many health practitioners have closed their offices due to the pandemic restrictions?

Yes. We are offering premium relief for all Traditional and myFlex insured non-refund customers for Health and Dental benefits, as follows:

For April 2020:

  • A 50% reduction on Dental premiums; and
  • A 20% reduction in vision and extended healthcare rates (excluding prescription drugs), which equates to an 8% reduction on Health premiums.

These reductions are retroactive to April 1, 2020 and will appear as a credit against the next available billing.

For May 2020:

  • A 50% reduction on Dental premiums in all provinces except Saskatchewan, where a 25% reduction will apply due to the re-opening of dental clinics in early-May; and
  • A 20% reduction on vision and extended healthcare rates (excluding prescription drugs) in all provinces, which equates to an 8% reduction on Health premiums.

These reductions are effective for May 2020 and will appear as a credit against the next available billing.

For June 2020:

  • A 25% reduction on Dental premiums; and
  • A 5% reduction on extended healthcare premiums.

These reductions are effective for June 2020 and will appear as a credit against the next available billing.

In order to be eligible for the monthly credit calculation and payout, a policy must be in force on the first of the month and remain in force thereafter. The monthly credit calculation is based on employees in force on the bill for that month. If employees experienced layoffs during the month, that would not affect eligibility for a premium credit as long as the benefit itself is not terminated.

We expect that claims experience and premiums will return to normal once the current pandemic restrictions are lifted.

In the meantime, plan members will continue to have full access to their benefits coverage throughout the pandemic. In many cases, dental offices remain open for emergencies services, and a variety of healthcare providers are available virtually.


Will the COVID-19 premium relief provided in April, May and June be extended into July?

No, we will not be offering premium reductions for July. As health practitioners have reopened their offices, we have seen claim volumes return to close to normal levels. We will continue to monitor the situation and communicate any future credits on a month-by-month basis.


Will the premium reduction on Health and Dental benefits have an impact on commissions?

We know the pandemic has put financial strain on your business as well, so we will continue to pay full compensation. Although your overall commission will be unaffected by these premium reduction adjustments, you may see a temporary reduction in your commission payments if you are on a pay-as-earned basis. We will begin to process the commission top-up payments in mid-June and will reflect both April and May premium credits.


Will the premium reduction on Health and Dental benefits have an impact on the renewals that were deferred?

No. Renewals will proceed as normal, with rate adjustments based only on months where full premium was paid. For most clients, we anticipate “normal” rate adjustments at renewal compared to rates paid prior to refunds taking effect.


Does this adjustment apply equally to clients who have had their renewal deferred?

Yes, these adjustments apply to all Traditional and myFlex insured, non-refund customers for Health and Dental benefits.


How does this affect clients who have terminated or amended a plan?

If a benefit is in-force during the month of June, the adjustment will be credited to the next available billing. For clients who have temporarily terminated all benefits, this will be applied against the first bill once benefits have been reinstated. No cash refunds will be paid.


I have a client who has temporarily terminated their benefits as of June 30, 2020 and is not able to reinstate their benefits due to financial difficulties. Are they eligible for the May premium relief credit?

For groups that have temporarily terminated due to COVID-19, we will apply the applicable premium credit to their first bill once they have reinstated their benefits.


Will you recover any of the adjustment at a future point in time?

No, we will not recover this adjustment.


Instead of this premium reduction adjustment, can a client cancel or adjust some of the benefits on their plan?

Yes, you and your clients always have the option of changing the coverage on a plan, such as reducing or removing a benefit to help control costs. Please speak to your Group Account Executive or myFlex Sales Manager about the options available.


Are TPAs and self-administered groups eligible for the premium reduction?

Yes. TPAs and self-administered groups are eligible for the premium reduction. However, timing for the credit will be dependent on the billing practices of the TPA or self-administered group. We will apply these credits as soon as we are able.


I have a client who has already received their July bill. Is the July bill going to be readjusted or are the premiums going to be retroactively credited on their August bill?

We will apply the Health and Dental premium reduction for June as a premium adjustment on the July bill and issue a new bill for July. It will take us some time to process all of these adjustments. 

If a client who is not on Pre-authorized debit (PAD) has already paid their bill by the time we apply the credits, then this overpayment will be reflected as a credit on their August bill. Credits for subsequent months will be communicated on a month-by-month basis.


What is the process for Third-Party Administrators and Self-Administered Groups to apply the premium reductions?

All standard customer billing processes remain in place. The intent is to provide a premium credit one month in arrears. This means that, on July bills, you can apply the Health and Dental premium reductions for June by issuing a credit as a premium adjustment (rather than a rate adjustment) for Non-Refund Insured Health and/or Dental benefits as follows:

  • A 25% reduction on Dental premiums; and
  • A 5% reduction on  extended healthcare premiums.

If you pay commissions, you should remit the premium, reduce it by commissions on the unreduced premium (as you normally would), and reduce it by the premium adjustments as described above. (Note the premium adjustment need not be reduced by the normal commission amount).

If Equitable Life pays commissions, you should remit the premium and reduce it by the premium adjustments, as described above.

In all cases, please submit an Excel summary of the dollar reduction applied for Health and Dental to each policy, at the same time you submit the remittance/bills.

Here are two examples of how to apply the premium reductions. These examples ignore taxes, and assume that the TPA is paying commissions to the advisor.

Before Credits
$100.00 Gross Premium (unreduced, including TPA fees) - this is premium to the client
$10.00 TPA Admin Fee
$90.00 Gross Premium (unreduced, but excluding TPA fees)
$10.00 Advisor Commission (unreduced)
$80.00 Net to Equitable (assuming TPA pays advisor commission)

Example #1: No change in dollar amount of TPA fee

After Credits
$55.00 Gross Premium (reduced, including TPA fees) - this is premium to the client
$10.00 TPA Admin Fee (assuming  the TPA fee is not reduced)
$45.00 Gross Premium (reduced, but excluding TPA fees)
$10.00 Advisor Commission (unreduced)
$35.00 Net to Equitable (assuming TPA pays advisor commission)

Example #2: TPA applies a reduced TPA fee

After Credits
$50.00 Gross Premium (reduced, including TPA fees) - this is premium to the client
$5.00 TPA Admin Fee (assuming a reduced TPA fee)
$45.00 Gross Premium (reduced, but excluding TPA fees)
$10.00 Advisor Commission (unreduced)
$35.00 Net to Equitable (assuming TPA pays advisor commission)


What if a Third-Party Administrator or Self-Administered Group has already paid previsou bills without applying the credits? Can the credits be applied to the July bill? 

Yes. If the previous credits have not yet been applied, they can both be applied to the July bill. Please follow the process for applying premium reductions described above.

 

We are a TPA and missed applying the June premium credits on our July bills. We are beginning work on our August billing. Should we apply only June credits on the August bill, or credits for both June and July? 

Thanks for letting us know. Yes, it is fine to apply the June credit to the August bill.


As a TPA, when applying the Health and Dental premium reductions to our bills, should we show them as a line-item credit, rather than flowing through the rates? Should the tax be indicated separately?

Yes, please apply the premium reductions as a line credit with tax indicated separately.


Do the Health and Dental premium reductions apply to ASO groups?

No. The Health and Dental premium reductions apply to Insured Non-Refund benefits only.


Are the Health and Dental premium reductions being applied per employee?  If so, how do I adjust for employee contributions? 

No. The premium reduction will appear on your bill as a credit applicable to health and/or dental benefits. Rates will not be adjusted in any way.

Each employer should review the Plan Member and Plan Sponsor contributions on their previous bill to determine what portion of the refund should be allocated to each employee. Note that the refund applies to both the premium and any applicable taxes.


I have a client who is terminating all benefits with Equitable Life at the end of this month and moving to a new carrier. Will they be eligible for the Health and Dental premium reductions?

No. Any plan sponsor who has terminated or is in the process of terminating their coverage with Equitable Life is not eligible for premium credits.


How will the Health and Dental premium reductions be reflected on the client’s bill? Is the refund going to appear as a single line or numerous adjustment transactions?

The refund will be clearly shown separately as Health and Dental premium adjustments. For provinces with sales tax, there will be also be separate adjustments for provincial tax. So, the refunds will appear as up to four adjustments depending on the client’s plan design and province – one for each of Dental premium, Dental tax, Health premium and Health tax.


I have a client who is ASO for Dental benefits, but whose Health benefits are insured. Are they eligible for the premium credit for their Health benefits?

Yes. The plan sponsor is eligible for the premium credit on their insured non-refund Health benefit.


I have a client who is not set up for pre-authorized debit (PAD) withdrawals but pay their premiums via cheque. Will the premium credit for June be applied to their August bill?

No. We are not waiting until August to apply the premium credit for June. Rather, we will issue a new bill for July with the premium reduction for June applied as a premium adjustment. If a client who is not on Pre-authorized debit (PAD) has already paid by the time we apply the credits, the credit will be carried forward to their August bill.


Will the premium credit on insured Health and Dental benefits be reflected on premiums and claims statements pulled online?

Yes. Premium credits have been applied appropriately to Health and Dental premiums and will be reflected on any premium in reports.


Does the premium credit for Extended Health Care apply to pooling charges? 

Yes. The 8% credit applies to the total Extended Health Care premium which includes pooling charges for insured groups


How will the COVID-19 premium relief affect renewals? Will future renewals reflect the reduction in Health/Dental premiums that were paid over a 2-3-month period, or will renewal rates be calculated as if full premiums were paid? 

The objective of any renewal is to establish premium rates that are adequate to cover expected future claims and expenses (including fees and commission) for both Health and Dental coverage.  Accordingly, we can only use prior claims experience to the extent that it is credible and an appropriate measure of future claims.  As such, it is necessary to exclude premiums and claims for months where premium credits were provided to the client.  This is because the claims in this period were not normal and are not a good measure of the future claims.

We started providing premium credits for the month of April, so any experience from April 1 onwards will be excluded from the calculations.  When credits cease, because claims have normalized, the experience will once again be included in our renewal calculations.    


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Infectious Disease Emergency Leave

In 2020,the Ontario government announced the Infectious Disease Emergency Leave (IDEL). Under this new regulation, employers are obligated to continue benefits for non-unionized employees who have had their hours reduced or terminated due to COVID-19, as long as benefits were in place as of May 29, 2020.The temporary rules expire on March 31, 2023.

How will this affect our organization if:

We temporarily laid off employees in Ontario due to COVID-19 and did not continue their benefits on or before May 29, 2020? 

You do not have to provide benefits to these employees while they are laid off 

We temporarily laid off employees in Ontario due to COVID-19 and continued their benefits past May 29, 2020? 

You are obligated to maintain those benefits and make contributions while the employees remain on IDEL (up to 6 weeks following the end of the declared emergency) 

We temporarily laid off employees outside of Ontario? 

This regulation does not apply. You may terminate or reinstate benefits according to the regulations in that province. 

In all cases, Equitable Life will abide by provincial legislation. We will also continue to demonstrate flexibility requested by employers to support the specifics of their situation during COVID-19.


What is required to remain in compliance with IDEL? Is there any special action we need to take to continue benefits for those employees whose benefit continuations will be expiring?

You are obligated to continue benefits for non-unionized employees who have had their hours reduced or terminated due to COVID-19, as long as benefits were in place as of May 29,2020.


Does IDEL apply to STD/LTD benefits as well?

Yes. If employees in Ontario were laid off due to COVID-19 and their STD/LTD benefits continued past May 29, 2020, then those benefits must continue to be provided while the employees remain on IDEL.


Can non-taxable disability benefits where the employee pays 100% of the premium be terminated if the employee does not want to pay, or does the new IDEL regulation mean these benefits must be continued?

If a plan member refuses to pay the required premium, the benefit can be terminated for that plan member.


Given that disability benefits where the employee pays 100% of the premium can be terminated if the employee does not want to pay (see question above), is the employee eligible to reinstate disability coverage when they return to work (provided the employer notifies Equitable Life within 31 days of their return to work date)?

Yes.
 

If an employee in Ontario has been temporarily laid off, but does not pay the premium for their health and dental benefits, can the benefits be terminated? 

Yes, if a plan member does not pay the required premium, the benefits can be terminated for that plan member.
 

Does an employer need to submit an exception request through Underwriting if, due to the new IDEL regulation, they will be providing benefits past Equitable Life’s normal 120-day limit?

No. Employers do not need to submit exception requests to extend benefits to employees beyond the 120-day limit in accordance with IDEL.

I have a client in Ontario who laid off employees due to COVID-19 and has continued benefits since before May 29th. They will still have employees off work when IDEL expireson March 31, 2023 and they are looking to extend benefits beyond that date.Will Equitable Life deem the lay-off provisions of the contract to take effect when IDEL expires andallow benefits to be extended beyond March 31, 2023?

Yes. We can consider the layoff to have begun March 31, 2023 at the end of the IDEL period.

If an employer is continuing benefits during a layoff, they are not required to let us know.

Our standard contract provisions allow for continuation of benefits for 90 days. However, when the layoff is driven by COVID, we are allowing up to 120 days without contacting us.

Does the ability to extend benefits beyond March 31, 2023 include disability?

Yes. The layoff periods described aboveinclude disability (on a premium paying basis). It is important to note that all plan members must be treated consistently.

Does the ability to extend benefits beyond March 31, 2023 apply to Administrative Services Only (ASO) groups?

The above also applies to ASO groups for Short-Term Disability, Health and Dental. If you have any customer-level specific situations, please work with your Underwriter.


Are there any restrictions around the extension of benefits for Out-of-Country coverage?

The Out-of-Country benefit day limitations, maximums, etc., remain in place.

As always, we encourage plan members who are planning to travel to contact Allianz before departing to confirm that they are covered for travel based on their specific destination and reason for travelling.


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Other


Can my clients quickly add the Homewood Employee and Family Assistance Program (EFAP) to our benefits?

We are ready to support fast amendments to add the Homewood EFAP to any existing Equitable Life policy. We do not require the standard 10 days for turn around and, in special needs situations, we can add within just a few days.


Are renewal deferrals available at this time?

Yes. Renewal deferrals are available on a case-by-case basis. A customized approach to each request allows us to consider the unique circumstances and needs of each individual client. Please speak with your Group Account Executive or myFlex Sales Manager.


Can a one-month extension can be given to any remaining balances in the Health Care Spending Account (HCSA) that are about to be forfeited as of March 31, 2020?

No. Unfortunately, Canada Revenue Agency (CRA) regulations do not allow for this type of concession.


With many health practitioners closing their offices due to COVID-19, will Equitable Life cover virtual paramedical services?

Yes. Equitable Life already does, and will continue to cover valid medical and paramedical services that are provided virtually by a Canadian provider. We adjudicate all claims – virtual or otherwise – based on the province of the plan member and subject to employer plan design and reasonable and customary amounts. Virtual providers may include: Chiropractors, Dietitians, Naturopaths, Occupational Therapists, Optometrists, Physiotherapists, Podiatrists, Psychologists, Social Workers, and Speech Therapists.

 

Will Equitable Life accept claims for virtual dental assessments over the phone?

Yes.


Are students who are home from school (pending the restart of classes) still covered as a dependent even if they no longer meet the full-time attendance requirement?

A student who is currently an eligible overage dependent under the plan will continue to be eligible for coverage if:

  • they have been attending school, and

  • they are no longer in school due to the current COVID-19 pandemic.

Their coverage will remain in place as long as they remain a registered student in that school.


Are there any options for my clients to pay premiums, other than by cheque?

Yes! We strongly encourage plan sponsors to move to pre-authorized debit. Automated payments are a convenient way to avoid missed payments, suspended claims and disruption to your benefits plan.
Complete the pre-authorized debit form and send to groupcollection@equitable.ca. Or contact Group Collections about online banking and electronic funds transfer (EFT).


Will Equitable Life make exceptions for plan members (or their dependents) who aren’t able to access health services or products due to COVID-19 closures, and their coverage ends before providers re-open?

No.


How are an advisor’s commissions impacted by delays in premium payments, or renewal deferrals?

The total amount of commission paid will not change provided all premiums are ultimately paid. What may change is the timing of when commissions are paid.

If commission is annualized, we wait until all premium is paid before processing both the settle-up and the next year’s annualization.

For commission in arrears, commissions are paid on actual premium received. A late premium would therefore result in a late payment of commission.


We are seeing an increase in employee stress levels. Do you have any resources we can share with our clients and their plan members?

Through our partnership with Homewood Health®, all of our clients and their plan members have access to a number of resources designed to provide guidance and support.

Homewood’s Online Cognitive Behavioural Therapy tool, i-Volve, can help plan members identify, challenge and overcome anxious thoughts, behaviours and emotions. All Equitable Life clients and their plan members have access to i-Volve. It’s available 24 hours a day, seven days a week, wherever they choose to access it. Learn more about Online CBT or access i-Volve at Homeweb.ca/Equitable.

As well, Homewood has created a number of resources to help support plan members dealing with increased anxiety during these uncertain times:


While implementing a new group during the COVID-19 situation, is Equitable Life being flexible with respect to accepting beneficiary designations?

Yes. If a group is using Online Plan Member Enrolment (OPME), the plan member simply provides their beneficiary designation electronically during the enrolment process and no further action is required.

Alternatively, in BC, Alberta, Ontario, Quebec and Saskatchewan, we can accept the beneficiary designations provided to the prior carrier. As long as we receive a file outlining who the prior carrier had listed as a beneficiary, we do not require a signed form from each plan member. Following implementation, we can send each plan member a benefit summary confirming the beneficiary we have on file and providing instructions on how to update their beneficiary, if necessary.

 

Given that patients may not be able to access their physician or obtain lab tests due to COVID-19, is Equitable Life allowing the extension of prior authorizations for prescription medication?

We are taking steps to help ensure that patients can continue to access the prescriptions they need. We recognize the need to be flexible at this time as patients may not be able to provide the information normally required to support a drug prior authorization renewal.

To ensure treatment continues, we are reviewing upcoming prior authorization expiries on a monthly basis and are granting 60-day extensions of prior authorization renewals during the COVID-19 crisis.

 

Equitable Life requires original documents for all life insurance claims. In the event our office closes due to COVID-19, would you allow scanned documents instead?

Yes. We will accept scanned documents for life claims up to $100,000 during the COVID-19 pandemic as we appreciate it can be challenging to get all the required documents. For claims over $100,000 we still require an Attending Physician Statement (APS).

 

In situations where an over-age dependent student was scheduled to graduate in spring 2020 but has had to extend their schooling, how can they ensure that their eligibility is extended?

Given that each student’s situation is unique, we ask that they please contact our Group Administration team and confirm the situation, including their anticipated date of graduation. They can reach our Group Administration team by email at groupbenefitsadmin@equitable.ca, or by phone at 1.800.264.4556.

 

My client’s plan member is taking a drug which required pre-authorization by Equitable Life and/or a provincial drug program, and their coverage is expiring. Is Equitable extending timelines for re-authorization?

Yes. Due to the impacts of the COVID-19 pandemic we are providing an extension of 60 days from the re-authorization expiry date.

This practice will continue until August 31st, at which point we intend to return to regular practices, while monitoring developments and adjusting accordingly if required.
 

What happens if, after the 60-day re-authorization extension, my plan member is still unable to obtain the necessary information for the re-authorization process?

We will continue to monitor the impacts of the COVID-19 pandemic and may provide additional extensions if necessary.

 

In situations where an over-age dependent student has a coverage end date of April 30, 2020, but they are unsure when their school term will end, can Equitable Life extend their coverage?  

Most education facilities have shifted to virtual learning and virtual exams and there has been little, if any, extension of the semester. In situations where a semester has been formally extended, we will support those students through the end of May 2020.  Given each student’s situation will be different, we do encourage plan members to reach out with questions and for any clarification. 

 

My client’s plan member has an over-age dependent who is supposed to start a post-secondary program for the first time this fall but their classes have been put on hold. If they are registered (over-age) students but can’t start classes due to COVID, can they still remain covered as eligible dependents? 

As long as an over-age dependent (within the age limits stipulated in their contract) is formally registered full-time in an accredited post-secondary program, they remain eligible under the terms of the contract.

This practice will continue until August 31st, at which point we intend to return to regular practices, while monitoring developments and adjusting accordingly if required.
 

Another insurer has announced that it is extending the following COVID-19 claims practice exceptions, including:

Paying claims that would normally require additional documentation, signatures, referrals or laboratory information. This applies if we already have these on file and they have expired. These include:

  • Prescription or doctor referral for paramedical services

    • Drug exception forms, which includes prior authorization and special authorization

    • Provincial Specialty drug program responses or documentation

  • Accepting health statements by email

Will Equitable Life be extending these claims practice exceptions as well?

Yes. Equitable Life claims practice exceptions are in place.

This practice will continue until July 1, 2021, at which point we intend to return to regular practices, while monitoring developments and adjusting accordingly if required.
 

Some dentists and other providers have begun to or are considering charging surcharges over-and-above the fee guides due to the need to invest in personal protective equipment and renovations. What is Equitable Life’s position as it relates to a COVID-19 surcharges by dentists or other practitioners?

We don’t currently cover COVID-19-related surcharges from dentists or other health providers. Along with CLHIA and other insurers, we will continue to monitor and review the situation.

 

Does Equitable Life provide reimbursement for COVID-19 screening tests?

COVID-19 tests are not eligible for coverage under traditional Extended Health Care benefits plans.
 
However, they are considered an eligible expense under a Health Care Spending Account (HCSA) or a Taxable Spending Account (TSA). 
 
For coverage of COVID-19 tests required to return to Canada, please see the Travel Assist section of this Q&A.


The Canadian Dental Association has created two new procedure codes due to COVID-19:

  • 99901   Non-aerosol generating procedures
  • 99902   Aerosol generating procedures

Will Equitable Life cover these new procedure codes?

We don’t currently cover these new procedure codes. Along with CLHIA and other insurers, we will continue to monitor and review the situation.


What happens if a plan member submits a claim that includes one of the new CDA procedure codes (99901 or 99902)?

If a plan member submits a claim which includes the new procedure codes, the claim will be auto adjudicated, and expenses related to the new procedure codes declined.


When dental claims flow through a client’s plan, are Personal Protective Equipment (PPE) reimbursements being processed automatically?

No. Currently, all charges for PPE on dental claims are declined.


Can a plan sponsor allow dental PPE charges to be reimbursed through their plan?

If a plan sponsor wishes to have dental PPE expenses paid as part of their plan, this can be arranged. This ability extends to insured, refund and ASO groups. It is not available for myFlex plans. It may include rate adjustments.

The plan sponsor must notify us in order to make this change.


To the best of your knowledge, is the addition of an expense line for dental PPE temporary (in line with the current COVID-19 pandemic) or will it form a permanent fixture as an eligible expense within your block of business?

It is our understanding that these are temporary codes, created to assist dentists in managing additional expenses they incur because of government health regulations to protect patients and health care workers during COVID-19.

If dental PPE expenses are made permanent, we can work with plan sponsors to either include or exclude these expenses in their plan, based on their preferences.


Is there a Reasonable and Customary limit applied to dental PPE expenses?

Yes. If a plan sponsor chooses to allow reimbursement of dental PPE expenses through their plan, the Reasonable and Customary limits applied will be based on the amounts established in the dental fee guide for each province or territory.

The process is as follows:

  • The Canadian Dental Association creates codes for PPE expenses
  • Each provincial or territorial dental association sets the dollar amount for the new codes and adds them to their fee guide
    • This amount defines the Reasonable and Customary limit for that province or territory
  • Each dentist can choose how much to charge their patients
  • Claims will only be paid up to the Reasonable and Customary limit in each province/territory


If health, vision and paramedical providers include additional charges for Personal Protective Equipment (PPE), will these expenses be covered?

Reimbursement of health, vision and paramedical claims is based on the Reasonable and Customary (R&C) amount for each service.

  • If the total amount claimed is within the R&C amount, we will pay the claim in full.  
  • If the total amount submitted is greater than the R&C amount for any reason, including the addition of PPE charges, we will pay the R&C amount only. 


What are the Reasonable and Customary amounts for various health care services?

We cannot provide a list of Reasonable and Customary (R&C) rates because they are subject to change at any time. In addition, rates may vary by province or region making it difficult to provide a list that applies to all plan members.

Plan members are always encouraged to get estimates and contact us to confirm the current rate for their product or service.


The Canada Revenue Agency (CRA) has relaxed its rules for the carry forward of HCSA credits. Will Equitable Life allow plan sponsors to extend their carry forward rule on their HCSAs?

For those plan sponsors who are seeking flexibility with respect to HCSA credits, we can support them by carrying over forfeited HCSA amounts (at the plan member level) into the next benefit period.


Are fees charged by healthcare providers for Personal Protective Equipment eligible for reimbursement through a Health Care Spending Account?

Personal Protective Equipment (PPE) fees embedded in a treatment charge are eligible for reimbursement through a Health Care Spending Account (HCSA). This applies to both dental codes created specifically for PPE charges, as well as PPE charges that may be incurred for health services and are indicated on the invoice.

If a plan member receives the COVID-19 vaccine and gets sick from it, could they be denied coverage for their health, disability and life benefits under their Group plan?

Contrary to misinformation being shared on-line, receiving a COVID-19 vaccine will have no effect on the ability to obtain coverage or benefits from life insurance or supplementary health insurance. We are aware of misinformation that is being spread through social media claiming that individuals who get the vaccine will not be able to get life insurance or may be denied their disability or life insurance benefits. These claims are incorrect and have no basis in fact whatsoever. Vaccination is one of the most effective ways to protect yourself and others from serious illness and death from COVID-19. Receiving the vaccine will not affect your individual or workplace life or health insurance benefits, or ability to apply for future coverage. As with any medication approved for use in Canada, the COVID-19 vaccines have been found safe and effective through Health Canada’s independent scientific and medical assessment process.

If a plan member elects NOT to receive the COVID-19 vaccine and subsequently contracts it, could they be denied coverage for their Travel Assist, health, disability and/or life benefits under their Group plan?

 

No. If a plan member chooses not to receive a COVID-19 vaccine, it would have no impact on any claim made under their Equitable Life group benefits plan. Equitable Life policies provide life, disability and health insurance based on the conditions outlined in the contract with us.
We will continue to follow the guidance and recommendations from the Canadian government to protect the health of Canadians, and we fully support government-approved vaccines as one of the most effective ways to protect yourself from serious illness or death from COVID-19.
Please note: While choosing not to receive the COVID-19 vaccine will not impact coverage under the Travel Assist out-of-country emergency medical benefit, some destinations require visitors to provide proof of vaccination before allowing entry into the country.
 

For all other questions, please contact your Group Account Executive or myFlex Sales Manager


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