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1. Tax impacts of the Canadian Dental Care Plan for your clients

   Tax impacts of the Canadian Dental Care Plan for your clients*

   
   Earlier this year, the government shared its progress on the Canadian Dental Care Plan (CDCP). 
   
   The CDCP will be available to Canadians with an annual family income of less than $90,000 who do not have dental benefits. Co-pays will be waived for eligible Canadians with a family income of less than $70,000. 
   
   Canadians who have access to private dental coverage are not eligible for the CDCP. This means that your clients must now report on T4s/T4As if dental coverage** was available on December 31 of the reporting tax year for:
   • Employees,
   • Employees’ spouses and/or dependents,
   • Former employees, and
   • Spouses of deceased employees.
   **Potential dental coverage includes Health Care Spending Accounts.
   
   This new tax reporting requirement is mandatory starting with the 2023 tax year. Employee tax slips will include new boxes for employers to complete:
   • Box 45 (T4): Employer Offered Dental Benefits. This new box will be mandatory.
   • Box 015 (T4A): Payer Offered Dental Benefits. This new box will be mandatory if plan sponsors report in Box 016, Pension or Superannuation. The box will otherwise be optional.
   Your clients should complete the boxes using the code system below. They should choose the appropriate code based on whether Dental coverage was available to the plan member – not whether the plan member has chosen to participate in the coverage.  For example, if a plan member has waived coverage or has chosen not to participate in the plan, they would still have access to coverage.
   • Code 1: The plan member has no access to dental care insurance or coverage of dental services of any kind.
   • Code 2: Only the plan member has access to any dental care insurance, or coverage of dental services of any kind.
   • Code 3: The plan member, their spouse and their dependents have access to any dental care insurance, or coverage of dental services of any kind. 
   • Code 4: Only the plan member and their spouse have access to any dental care insurance, or coverage of dental services of any kind. 
   • Code 5: Only the plan member and their dependents have access to any dental care insurance, or coverage of dental services of any kind. 
   Your clients can find further information about completing tax slips for employees on the Canada Revenue Agency’s website:
   • T4
   • T4A

   Reports for dependents

   We have a report available for plan members who have enrolled their dependents in benefits coverage. Your clients can contact their local service team representative to receive a copy of the report. We are working to make it available on our Advisor and PA websites.
    

   Questions

   For guidance on your tax slips and reporting obligations, please encourage your clients to contact their accountant, payroll provider or tax advisor.
    

   Supporting plan members affected by the Israeli-Palestinian conflict*

   
   Traumatic events continue to unfold in the Middle East. Enduring ongoing news of conflict and suffering could challenge many Canadians. During this difficult time, Equitable encourages affected clients and plan members to access the mental health support they need. 

   
   Support available to all Equitable plan members

   Large-scale traumatic news events can cause people to experience intense reactions. This puts a lot of strain on their mental health. Having coping mechanisms to deal with the current crisis can be a huge help. Any Equitable Life plan member who needs mental health support can visit Homeweb.ca/equitable to access online resources or contact Homewood at 1.888.707.2115.  
    

   Support available to plan members with the Homewood Health EFAP

   For your clients that have purchased Homewood Health’s Employee and Family Assistance Program (EFAP), remind them that their plan members also have access to confidential counselling services. The EFAP provides plan members with 24/7 access to confidential counselling through a national network of mental health professionals. Whether it’s face-to-face, by phone, email, chat or video, plan members and their dependent family members will receive appropriate, timely support for the issue they’re dealing with. 
     

   Questions? 

   If you need more information, contact your Group Account Executive or myFlex account executive.
   
   *Indicates content that will be shared with your clients. 
2. [pdf] A Retirement Savings Plan is just as relevant now as it was over 60 years ago
3. Update: Improved Employee Assistance from Homewood Health

   As we announced in June, we are expanding our relationship with Homewood Health to help you meet the mental health and wellness needs of your employees and their families. Beginning Oct. 1, 2019, Homewood will be the new provider of both our Employee and Family Assistance Program (EFAP) and our online health and wellness services.

   Following the transition to Homewood, plan members will benefit from added features:

   • Signing in to Homewood Health online allows the platform to customize content unique to your interests.
   • All plan members will have access to a Health Risk Assessment to help identify health and wellness barriers.
   • i-Volve, Homewood's online cognitive behavioural therapy program is available for all plan members to help them manage anxiety and depression.

   Learn more about Homewood Health and how they will be providing your plan members with exceptional EFAP and online health and wellness resources.

   What does the transition to Homewood mean for you and your plan members?

   We will be working with you in the coming months to facilitate the transition and support your employees. Most importantly, there will be no disruption of service delivery to employees who are currently in short-term counselling with our current EFAP provider.

   The transition timeline

   Groups without an EFAP

   Online health and wellness resources will be available through EquitableHealth.ca just as they are now. Here's what you can expect in the coming months.

   September   

   • We will send plan administrators an email with more details about the resources available to assist in the transition, including:
     • How to register for Homewood Health online
     • A video orientation for plan members

   October

   • October 1^st – plan members can access the Homewood online resources! They simply need to visit homeweb.ca/Equitable to sign up and create their unique login.

   The transition timeline

   Groups with an EFAP

   We’ve created a helpful infographic that outlines the steps involved in the transition to the Homewood Health EFAP over the coming months. Please save or print it for easy reference. Below are some of the highlights.

   August

   • We will send plan administrators an email with official notice that the enrolment certificate for our current EAP provider, LifeWorks, will terminate on Sept. 30, 2019, and that Homewood Health Inc. will be our new Employee Assistance Program provider as of Oct. 1.

   September   

   • Homewood will send you a welcome email, including how to access the EFAP, who to contact for support and where to find resources to help share the news with plan members.
   • Homewood will follow up directly to answer any questions you may have.
   • Homewood will begin offering orientation and training sessions for both plan administrators and plan members. These will be running throughout the fall so you can attend at your convenience. 

   October

   • October 1^st – plan members can access the Homewood EFAP and online resources! They simply need to visit homeweb.ca/Equitable to sign up and create their unique login.
   • Orientation and training sessions will continue to be available for both plan administrators and plan members throughout October.

   Learn More

   The resources listed below answer common questions about Homewood and our EFAP transition:

   • EFAP Transition Infographic
   • Homewood Health - Improving Life
   • EFAP Transition FAQ
   • About Homewood

   If you have a question that is not addressed here, please contact your Group Account Executive or myFlex Sales Manager.

4. Equitable Life Group Benefits Bulletin - October 2022

   Introducing new Gender Affirmation Coverage for group benefits plans

   Providing an inclusive benefits plan can play a critical role in fostering a workplace culture that welcomes diversity and helps employees thrive. While most provinces cover the cost of gender-affirming surgery, each person has unique needs. Some may require procedures that are not publicly covered.
   
   That’s why we’re pleased to introduce a new coverage option for gender affirmation surgical procedures that are not covered by provincial health plans. Gender Affirmation Coverage helps plan sponsors to close the gap where provincial health coverage ends. 

   Coverage details and eligibility

   Gender Affirmation Coverage can be added to any Equitable Life plan with an in-force Extended Health Care plan. It provides coverage for gender-affirming procedures that are not covered by provincial health plans. This might include tracheal (Adam’s apple) shaving and voice surgery. It will also cover some additional procedures to further align the plan member’s features to the transitioned gender, such as facial bone reduction and cheek augmentation. This makes a wider variety of gender-affirming surgeries accessible to plan members and helps minimize their out-of-pocket costs.
   
   Plan members are eligible for coverage with a diagnosis of gender dysphoria from a qualified health care professional. 

   Offering a more inclusive benefits plan

   The coverage provides one more way for your clients to offer more inclusive coverage and to offer holistic support to their plan members undergoing a gender transition. We have developed this coverage as a complement to our existing coverage options, including Health Care Spending Accounts (HCSAs), Taxable Spending Accounts (TSAs), Extended Health Care and drug coverage, and Employee and Family Assistance Programs, all of which can provide support to plan members undergoing gender affirmation.
   
   We regularly review our products to ensure that they’re meeting your clients’ needs, and we’re committed to offering products that support diversity, equity and inclusion.
   
   We also continue to review our forms, documents and processes to make them more inclusive. This includes reviewing our online plan member enrolment (OPME) tool to allow for more flexibility with the way plan members identify their gender. 

   Gender affirmation and mental well-being

   Gender affirmation procedures can lead to improved mental health outcomes for those with gender dysphoria, as most report an improvement in their quality of life following the procedures. Gender dysphoria may occur when a person’s assigned sex at birth does not match their identity, and people experiencing gender dysphoria typically report psychological and emotional distress, including symptoms of depression or anxiety. By offering coverage where provincial health coverage ends, your clients can support plan members as they seek procedures that align their body presentation with their self-identified gender.
    

   Advantages at a glance

   Advantages for plan members include:
   • Reimbursement for some procedures and expenses, leading to fewer out-of-pocket costs
   • May experience improved mental health outcomes after surgery
   Advantages for plan sponsors include:
   • A benefits plan that promotes a culture of diversity, equity and inclusion, which may build employee loyalty
   • Support for plan member mental health to help those with gender dysphoria thrive
   For more information about how Equitable Life benefits plans can support the needs of those seeking gender affirmation surgery view our resources: 
   • Guide to Gender Affirmation Procedures and Therapies
   • Gender Affirmation Coverage Overview
   You can also contact your Group Account Executive for more information. If you have clients with myFlex plans who are interested in Gender Affirmation Coverage, please contact your myFlex Sales Manager to determine eligibility. 
    

   The Benefits Canada 2022 Health Care Survey results are in!

   Equitable Life is proud to be a Platinum sponsor for The Benefits Canada 2022 Health Care Survey, Canada’s leading survey on workplace benefits plans. This year’s survey report highlights many fascinating insights across a wide variety of benefits topics, including:
   • A focus on mental health for both plan sponsors and plan members
   • The repercussions of the "shadow" pandemic due to health care delays 
   • Trends in plan members' overall perceptions of their health benefits plans
   • The types of benefits getting more attention from plan members
   • The role of remote work in plan member satisfaction
   By surveying plan members and plan sponsor representatives across Canada each year, Benefits Canada works with its Advisory Board to provide timely insights on the employee benefits issues that are most important to Canadians. This year, our Group Vice-President of Western Sales, Meghan Vallis, has provided her expertise as an Advisory Board member.
   
   We’re committed to helping you and your clients navigate the evolving landscape of employee benefits in Canada by contributing to this vibrant industry community. To read the full report, visit Benefits Canada.
    

   HCSA and TSA manual allocation reminder

   If your clients’ Health Care Spending Account (HCSA) and/or Taxable Spending Account (TSA) have manual allocations, they need to allocate these amounts to plan members each year. Clients should review their plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year. Your clients may also order HCSA and TSA forfeiture reports on EquitableHealth.ca. 
    
   If your clients have Plan Administrator update access on EquitableHealth.ca, they can update these amounts online by doing the following:
   • Select View certificate
   • Select Health Care Spending Account or Taxable Spending Account
   • Select Update Allocation in Task Center
   • Enter amount in Revised Allocation Amount
   • Override Reason – Plan Administrator Request
   • Select Save
   If your clients have Plan Administrator reporting access on EquitableHealth.ca, they can determine which plan members have a zero allocation by running the HCSA Totals by Plan Member report online by doing the following:
   • Select Reports
   • Select New
   • Select Next
   • Select HCSA or TSA Totals by Plan Member
   • Select Next
   • Enter end date of 12/31/2022
   • Select Next
   • Select Finish
   • View Report
   To provide us with the amounts to be updated, please have your client contact our Group Benefits Administration Team at GroupBenefitsAdmin@equitable.ca. 
   
    
5. Equitable Life Group Benefits Bulletin – September 2021 In this issue:
   • Right drug, right dose*
   • Responding to New Brunswick’s Biosimilar Initiative*
   • Helping plan members access our convenient digital options*
   • Reminder: Please access forms on EquitableHealth.ca*
   • Over-age dependents losing coverage?*
   *Indicates content that will be shared with your clients

   Right drug, right dose

   Equitable Life partners with Personalized Prescribing Inc. to help plan members avoid treatment trial and error
    
   Patients suffering from mental health conditions often need to try several medications before they find one that works for them. This is frustrating and can result in negative side-effects, a longer recovery, lost productivity, or a delayed return to work.
    
   To help plan members avoid this treatment trial and error, we have partnered with Personalized Prescribing Inc. to provide easier access to pharmacogenomic testing for plan members with mental health conditions.
    
   Pharmacogenomics 101
   Pharmacogenomics is the study of how an individual’s genes influence their response to medications. Pharmacogenomic testing can help determine how compatible a patient’s body may be to a particular drug, and helps their physician prescribe the most appropriate medication. The goal is to ensure the right drug is prescribed to deliver the most positive outcome with the fewest side effects.
    
   Easier access to pharmacogenomic testing
   Through our partnership with Personalized Prescribing Inc., any Equitable Life plan member diagnosed with a mental health condition can purchase a pharmacogenomic test for a discounted price of $399 plus HST – a 20% savings.
    
   We are also introducing the option for plan sponsors to add coverage of pharmacogenomic tests provided by Personalized Prescribing Inc. for mental health conditions.
    
   With this coverage, plan members are eligible for pharmacogenomic testing if:
   • They have been diagnosed with a mental health condition;
   • They are currently taking or have stopped taking a medication for a mental health condition that does not work or has side effects; and
   • The pharmacogenomic test is conducted by Personalized Prescribing Inc.
   How it works
   Getting a test is easy. The plan member starts by visiting www.personalizedprescribing.com/equitablelife to request a test kit.
    
   Once they receive their test kit from Personalized Prescribing Inc., they simply provide a saliva sample and send it back (postage is pre-paid). Within 7-10 business days, they receive an Rx Report™ that they can share with their doctor. This report includes details to help their doctor prescribe the right drug and the right dose for them.
    
   Benefits for plan members:
   • The plan member and their physician receive a full report that is easy to understand;
   • The report identifies the most compatible medications for the plan member’s condition and the medications to avoid;
   • The physician is able to prescribe the most appropriate medication with the fewest side effects; and
   • The plan member avoids medication trial and error.
   Benefits for employers:
   • Pharmacogenomic testing can be an effective prevention strategy to help employees stay healthy and potentially avoid a mental health-related work absence; and
   • Employees suffering from mental health conditions may be more productive when they are on the right medication for them.
   To learn more about pharmacogenomic testing through Equitable Life and Personalized Prescribing Inc., please visit www.personalizedprescribing.com/equitablelife. To request coverage for your clients, please contact your Equitable Life Group Account Executive or myFlex Sales Manager.

   Responding to New Brunswick’s Biosimilar Initiative

   We are changing coverage for some biologic drugs in New Brunswick in response to the province’s Biosimilar Initiative. These changes will help protect your clients from additional drug costs while still providing access to equally safe and effective biosimilars.
    
   What is New Brunswick’s Biosimilar Initiative?
   New Brunswick’s Biosimilar Initiative will end provincial coverage of several originator biologic drugs for some or all conditions beginning on December 1, 2021. Patients who are using these drugs for the affected conditions will be required to switch to biosimilar versions of the drugs to maintain coverage under the province’s government drug plan.
    
   What is the impact on private drug plans?
   The most significant risk to plan sponsors who maintain coverage of originator biologics is coordination of benefits (CoB) risk. If other insurance carriers follow suit with the province and delist the originator biologics, it could expose a plan that doesn’t delist them to significant coordination of benefits risk.
    
   For example, consider a patient who is covered under two private plans – their employer plan and a spousal plan. If their employer plan was the first payer for the originator biologic but delists the drug, the spousal plan now becomes the first payor. If the spousal plan continues to cover the cost of the originator, it now pays most or all of the cost of the drug.
   
   How is Equitable Life responding?
   To protect your clients’ plans from paying additional and avoidable drug costs, we are changing coverage in New Brunswick for most biologic drugs included in the provincial initiative.
    
   Beginning Feb. 1, 2022, plan members in New Brunswick will no longer be eligible for coverage of Humira, Lantus, Humalog and Copaxone if they have a condition for which Health Canada has approved a lower cost biosimilar version of the drug. These plan members will be required to switch to a biosimilar version of those drugs to maintain coverage under their Equitable Life plan.
    
   How will Equitable Life communicate this change to plan members?
   We will be communicating with affected claimants in early-December 2021 to allow them ample time to change their prescriptions and avoid any interruptions in their treatment or their coverage.
    
   Can my client maintain coverage of these biologic drugs?
   All groups, except myFlex clients, who wish to opt out of this change and maintain coverage of these originator biologics for New Brunswick plan members can submit a policy amendment. Amendments must be submitted no later than Nov. 30, 2021.
    
   Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for New Brunswick plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.
    
   Groups that opt out of this change are also opting out of any future changes to our New Brunswick biosimilar initiative. Their drug plans will continue to cover any additional originator biologics that we subsequently add to the program.  
    
   Will this change impact my clients’ rates?
   The rate impact of this change and  any cost savings associated with the change will be factored in at renewal.
    
   If plan sponsors opt out of these changes and maintain coverage for the originator biologics, it may result in a rate increase. Any rate adjustment will be applied at renewal.
    
   What is the difference between biologics and biosimilars?
   Biologics are drugs that are engineered using living organisms like yeast and bacteria. The first version of a biologic developed is also known as the “originator” biologic. Biosimilars are also biologics. They are highly similar to the originator drug they are based on and have been shown to have no clinically meaningful differences in safety or efficacy.
    
   Questions?
   If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
    

   Helping plan members access our convenient digital options

   Some of your clients’ plan members aren’t benefitting from our secure and convenient digital options to access and use their Group Benefits. They can sign up to submit claims electronically for faster claim payments, get claim payments deposited directly to their bank accounts, easily review their coverage details, quickly access their Group Benefits plan booklet, benefits card and more. We’ve made it easier than ever to sign up, with more resources all conveniently located at Equitable.ca/go/digital.

   Your clients’ plan members can visit this link to view:
   • A brochure with all the high-level instructions they need to get started on EquitableHealth.ca and the EZClaim mobile app
   • A full video guide on how to access and navigate EquitableHealth.ca
   If your clients’ plan members need help activating these services, they can give us a call at 1-800-265-4556 and select the option for web support. We’d be happy to help!
    

   Reminder: Please access forms on EquitableHealth.ca*

   We routinely update our Plan Administrator forms on EquitableHealth.ca based on their feedback and to stay compliant with legal and/or regulatory requirements. If your clients need a form, they should always pull the most recent version from EquitableHealth.ca instead of reusing forms they have saved on their computer. Using an old or outdated form may result in processing delays.
    
   Your clients can access the Plan Administrator forms by following these steps:
   • Login to EquitableHealth.ca
   • Select “Documents”
   • Toggle between English and French forms
   • Click on the document name to download a PDF copy

   Over-age dependents losing coverage?*

   Some of your clients’ plan members may have dependents who are reaching the maximum age for eligibility under their group benefits plan.
    
   If they are attending school full-time or are disabled, they may be eligible for continued coverage. Plan members with over-age dependents can simply complete the Application for Coverage of Dependent Child Over Age 21 (Form #441) and submit it through our online document submission tool. They can access the tool by logging into their Group Benefits account at www.equitablehealth.ca and clicking My Resources. 
   
   If they are not attending school full-time or disabled, they will no longer be covered under the plan. However, they may be eligible for Coverage2go®. It allows individuals who are losing their group coverage to purchase personal month-to-month health and dental coverage that is affordable, reliable and works like their previous group benefits plan. They can choose the level of coverage and protection that suits their personal situation.
   
   There are no medical questions – they simply need to apply within 60 days of losing their health coverage under their group benefits plan.*
    
   Help your clients’ plan members and their dependents who are losing coverage by letting them know about Coverage2go. They can visit our website to learn more about Coverage2go and to get a quote.
     
   *Quebec residents are not eligible for Coverage2go
6. Faster claims processing on Equitable EZClaim Mobile

   Equitable Life now provides real-time processing of massage therapy, physiotherapy and chiropractor claims submitted via the EZClaim® Mobile app.

   That means plan members will be able to find out the status of their claim almost instantaneously. And, for approved claims, they will receive payment even sooner – often in as little as 24 hours.

   Equitable Life plan members can submit all types of health and dental claims via EZClaim Mobile, including co-ordination of benefits and Health Care Spending Account claims. Currently, 43% of all claims are submitted through the user-friendly app.

   “We know plan members love the speed and convenience of EZClaim Mobile,” says Norma Crouse, Assistant Vice-President of Claims and Administration at Equitable Life. “With these enhancements, some claims submitted through the app will be processed and paid even faster.”

   We’re also adding biometric login functionality to allow plan members to sign in to the app using their face or fingerprint. And we’ve redesigned our landing page on the mobile app to make it easier for plan members to navigate the various features of the app.

7. Exchanges
8. Equitable Life Group Benefits Bulletin – January 2022

   Short-term disability coverage for plan members with COVID-19*

   Please note: This announcement applies only to groups with short-term disability coverage through Equitable Life
    
   As the COVID-19 pandemic continues, and the situation evolves, we continue to adjust our practices to ensure ongoing support for our plan members.
    
   PCR tests no longer required for COVID-related STD claims
    
   Some provinces have recently restricted access to COVID-19 PCR testing to only high-risk individuals. To ensure your clients' eligible plan members receive their short-term disability benefits in a timely manner, we no longer require a positive PCR test for plan members submitting COVID-19-related STD claims.
    
   Plan members who are experiencing symptoms of COVID-19 or who have tested positive for the virus (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 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.
    
   Waiting periods for COVID-related STD claims
    
   To support your clients' plan members during the initial stages of the pandemic, we waived the 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. 
9. Responding to Alberta's Biosimilar Initiative

   Beginning March 15, 2021, we are changing coverage for some biologic drugs in Alberta in response to the province’s Biosimilar Initiative. These changes will help protect your clients from additional drug costs that may result from this new government policy while still providing access to equally safe and effective biosimilars.

   What is Alberta’s Biosimilar Initiative?

   Alberta’s Biosimilar Initiative will end provincial coverage of several originator biologic drugs for some or all conditions beginning on Jan. 15, 2021. Patients 18 and over who are using these drugs for the affected conditions will be required to switch to biosimilar versions of the drugs to maintain coverage under the province’s government drug plan.

   What is the impact on private drug plans?

   Industry response to Alberta’s Biosimilar Initiative has the potential to significantly impact your clients’ drug plan costs. If other insurance carriers follow suit with the province and delist the originator biologics, it could expose a plan that doesn’t delist them to significant coordination of benefits risk. (See Case Study below.)

   How is Equitable Life responding?

   To protect your clients’ plans from paying additional and avoidable drug costs, we are changing coverage in Alberta for most biologic drugs included in the provincial initiative.

   As of March 15, 2021, several originator biologic drugs will no longer be covered for plan members of all ages in Alberta. Plan members taking these biologics will be required to switch to the biosimilar versions of these drugs to maintain eligibility under their Equitable Life plan.

   What drugs and conditions are affected?

   The following table outlines the drugs and conditions that will be affected by this change. The list of affected drugs or conditions is dynamic and will change as Alberta includes more biologic drugs in its Biosimilar Initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.

   Drug name	Originator biologic   These drugs will no longer be covered in Alberta for the conditions listed in this table.	Biosimilar   Plan members will need to switch to these medications to maintain coverage under their Equitable Life plan.	Affected health conditions   The changes in coverage apply to these conditions.
   Etanercept	Enbrel	Brenzys Erelzi	Ankylosing Spondylitis Rheumatoid Arthritis Polyarticular juvenile idiopathic arthritis (JIA) Psoriatic Arthritis Plaque Psoriasis (adults and children)
   Infliximab	Remicade	Inflectra Renflexis Avsola	Ankylosing Spondylitis Plaque Psoriasis Psoriatic Arthritis Rheumatoid Arthritis Crohn's Disease (adults and children) Ulcerative Colitis (adults and children)
   Insulin glargine	Lantus	Basaglar	Diabetes (Type 1 and 2)
   Filgrastim	Neupogen	Grastofil Nivestym	Neutropenia
   Pegfilgrastim	Neulasta	Lapelga Fulphila Ziextenzo	Neutropenia
   Glatiramer*	Copaxone	Glatect TEVA-Glatiramer Acetate	Multiple Sclerosis

   *Glatiramer is a non-biologic complex drug.

   How will Equitable Life communicate this change to plan members?

   We will be communicating with affected claimants in January 2021 to allow them ample time to change their prescriptions and avoid any interruptions in their treatment or their coverage.

   Can my client maintain coverage of these biologic drugs?

   Traditional groups who wish to opt out of this change and maintain coverage of these originator biologics for Alberta plan members can submit a policy amendment. Amendments must be submitted no later than January 15, 2021. Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for Alberta plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.

   Will this change impact my clients’ rates?

   The rate impact of this change in coverage will be relatively insignificant. Any cost savings associated with the change will be factored in at renewal.

   If plan sponsors opt out of these changes and maintain coverage for the originator biologics, it may result in a rate increase. Any rate adjustment will be applied at renewal.

   What is the difference between biologics and biosimilars?

   Biologics are drugs that are engineered using living organisms like yeast and bacteria. The first version of a biologic developed is also known as the “originator” biologic. Biosimilars are also biologics. They are highly similar to the originator drug they are based on and have been shown to have no clinically meaningful differences in safety or efficacy.

   Questions?

   If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.

   CASE STUDY: The Alberta Biosimilar Initiative and Coordination of Benefits (CoB) risk

   CoB risk is real and can be significant, even if a pharmaceutical savings program exists.

   The industry response to Alberta’s Biosimilar Initiative has the potential to significantly impact your clients’ drug plan costs. Some insurers may follow the province’s lead and delist these originator biologics. Others may cut back coverage to the cost of the biosimilars or maintain coverage of the originators. These differences could expose a plan that doesn’t delist the originator biologics to significant coordination of benefits risk. Here’s how:

   Let’s assume there are two private drug plans – Plan A and Plan B. Both plans are open plans with no deductible. Plan A has 80% co-insurance and Plan B has 100% co-insurance.

   BEFORE Alberta’s Biosimilar Initiative

   Before Alberta’s Biosimilar Initiative, both plans cover the originator biologics listed above.

   Plan A is the first private payer for an Alberta plan member taking an originator biologic drug for Rheumatoid Arthritis. Plan B is the second private payer. The cost of the originator biologic for the plan member is $30,000 annually. Here’s how the coordination of benefits would look before Alberta’s Biosimilar Initiative.

   

   
   AFTER Alberta’s Biosimilar Initiative

   In response to Alberta’s Biosimilar Initiative, the insurer for Plan A delists the originator biologic and requires plan members to switch to the biosimilar. The insurer for Plan B maintains coverage of the originator biologic. Under this scenario, if the plan member doesn’t switch, Plan B essentially becomes the first payer and sees their annual cost increase by 400% (from $6,000 to $30,000).

   

   
   Even if the insurer for Plan B cuts back coverage to the cost of the biosimilar or adjusts the paid amount because they have a savings program in place with the drug manufacturer, the impact could be significant. For example, if the insurer cuts back coverage to 50% (or $15,000 annually), Plan B would see a 150% annual cost increase (from $6,000 to $15,000):

   

10. Supporting you and your group clients during the COVID-19 pandemic

    We know these are challenging times.

    As COVID-19 continues to spread, we want to reassure you that we remain ready and committed to support you, your group clients and their plan members.

    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.

    As the situation continues to develop, we know you will have questions about what it means for your clients and their plan members. We have already issued announcements related to Travel Assist coverage for plan members who are outside of the country, and about short-term disability coverage for plan members who are in quarantine or self-isolation. We will continue to provide timely updates as developments unfold.

    All of us are facing an unprecedented number of urgent situations where there is no established protocol. Our commitment to you and your clients is to respond quickly, and to be flexible where we can, tailoring solutions to specific needs. The global situation is evolving rapidly; we ask for your patience as our solutions also evolve quickly and accordingly. Your Group Account Executive and myFlex Sales Manager are well equipped to navigate Equitable Life’s experts and to resolve difficulties.

    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.