Equitable Life Group Benefits Bulletin - November 2022

The importance of timely plan member eligibility updates*

Effective Dec. 1, 2022, we are implementing a revised process for managing plan member and dependent health and dental claims that have been incurred and paid after coverage has been terminated. This new process is consistent with industry practices.
 
If health or dental claims have been incurred and paid after a plan member’s termination date but before we received notice of the termination, we will align the plan member’s or dependent’s termination date with the service date of the last paid claim, retaining premiums up until that date.
 
If no claims have been incurred and paid after the termination date, Equitable Life will process the termination as requested and refund any excess premium, subject to a maximum premium refund credit of three months.
 
Currently, we process the termination as requested and attempt to recover any claim overpayments directly from the plan member. We then refund any excess premiums that have been paid, subject to the maximum refund credit amount.
 
To avoid claims being incurred and paid after a plan member’s termination date, it is important for your clients to update plan member and dependent eligibility dates on or before the effective date of the change.
 
If you have any questions about the process your clients should follow for updating plan member eligibility, please contact your Group Account Executive or myFlex Sales Manager.

QuickAssess®: Absence and accommodation request review services*

It can be difficult to navigate chronic or complex cases of absenteeism or accommodation requests. That’s where QuickAssess® can help.
 
QuickAssess is an optional, fee-per-use service that can provide your clients with an unbiased, timely assessment of complex plan member absences and workplace accommodation requests. Our disability experts can provide recommendations to help your clients manage:

• Workplace absences
• Chronic or patterned absenteeism
• Requests to modify workplaces or duties
• Return-to-work coordination
• Employee Insurance sick leaves

Based on a thorough review of information provided by the plan sponsor, the plan member, and their physician, our QuickAssess specialists provide a recommendation within two business days on how to manage the absence or accommodation request.** Your clients can then decide how to manage the plan member request and communicate their decision accordingly.
 
For more information on using QuickAssess, including eligibility requirements, please contact your Group Account Executive or myFlex Sales Manager.

**Within two business days of receiving a completed QuickAssess Absence and Accommodation Review Referral Form and all required information. For more complex referrals, more time will be required.

Finding a health care provider with TELUS eClaims direct billing*

By visiting TELUS’s Find a Provider page, your clients’ plan members can now easily search for paramedical and vision providers who are registered on the TELUS Health eClaims network and who can submit claims directly to us on behalf of their patients. Searches can be filtered by postal code to help plan members find the most convenient provider options.

As our direct billing provider for pharmacy, vision and paramedical claims, TELUS Health has an extensive network of 70,000 health care providers that provide direct billing to streamline the claims process.

Please note, plan members should always check Equitable Life’s list of de-listed providers before selecting a health care provider. The list is available for your clients and their plan members on EquitableHealth.ca, and is updated regularly.

For more information about TELUS eClaims, please contact your Group Account Executive or myFlex Sales Manager.

First phase of the Canada Dental Benefit proposed for Dec. 1, 2022*

The federal government’s new Canada Dental Benefit is proposed to take effect on Dec. 1, 2022, subject to Parliamentary approval. The program will cover eligible expenses retroactive to Oct. 1, 2022, and this first phase would apply to Canadians under 12 years of age.

If implemented, the Canada Dental Benefit will provide dental care to Canadian families with under $90,000 adjusted net income annually. By 2025, the federal government expects to extend the benefit to children under 18, senior citizens and Canadians with disabilities.

Parents or guardians will be required to apply for this coverage through the Canada Revenue Agency (CRA) and must not have private dental coverage for the child(ren).

This new program will have no impact on your clients’ dental coverage and no action is required on their part.

* Indicates content that will be shared with your clients.