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January 2023 eNews
Responding to Saskatchewan’s biosimilar switch initiative*
We are changing coverage for some biologic drugs in Saskatchewan in response to the province’s biosimilar initiative. These changes will help protect your clients’ plans from additional drug costs that may result from this new government policy while providing access to equally safe and effective lower-cost biosimilars.
Saskatchewan’s provincial biosimilar initiative
Announced in October 2022, the Saskatchewan Biosimilars Initiative ends coverage of ten biologic drugs beginning on April 30, 2023.
Patients in the province who are using these drugs will be required to switch to biosimilar versions of these drugs by April 30, 2023, in order to maintain their Saskatchewan Drug Plan coverage.
Equitable Life’s response
To ensure this provincial change doesn’t result in your clients’ plans paying additional and avoidable drug costs, we are changing coverage in Saskatchewan for most biologic drugs included in the provincial initiative.
Beginning April 30, 2023, plan members in the province will no longer be eligible for most originator biologic drugs 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 the drug to maintain coverage under their Equitable Life plan.
Communicating this change to plan members
We will inform any affected plan members in early February of the need to switch their medications so that they have ample time to change their prescriptions and avoid any interruptions in treatment or coverage.
What is the difference between biologics and biosimilars?
Biologics are drugs that are engineered using living organisms like yeast and bacteria. The first version of a biologic developed is known as the “originator” biologic. Biosimilars are highly similar to the drugs they are based on and Health Canada considers them to be equally safe and effective for approved conditions.
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
**The list of affected drugs is dynamic and will change as Saskatchewan includes more biologic drugs in its biosimilar initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.
Ontario announces 2023 biosimilar switch program*
The government of Ontario recently announced the launch of a biosimilar initiative to switch patients from eight originator biologic drugs to biosimilar versions of the drugs.
Patients in Ontario using affected originator biologic drugs will have until December 29, 2023 to switch to a biosimilar version of their medications in order to maintain coverage under the province’s public drug plans.
We are actively monitoring and investigating the impact of this new policy on private drug plans in Ontario. We plan to implement changes to coverage of biologic drugs in the province in 2023 to help prevent this change from resulting in additional costs for our clients’ drug plans. We will provide more details in the coming months.
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager.
Dental fee guide updates*
Each year, Provincial and Territorial Dental Associations publish fee guides. Equitable Life® uses these guides to help determine the reimbursement limits for dental procedures. For your reference, below is the list of the average dental fee increases for general practitioners that will be used by Equitable Life for 2023.***Dental fee guide increases over 2022***
***Data for all provinces and territories was not available at the time of publication. This chart will be updated on EquitableHealth.ca as more information becomes available.
Equitable Life ranks high with Canadian group advisors*
Equitable Life ranked second nationally and first in Ontario among major insurers in a recent survey of Canadian group benefits advisors.
NMG Consulting, a leading global consulting firm, conducted in-depth interviews with 130 leading group consultants, brokers and third-party administrators across the country between May and August 2022 for its annual Canadian Group Benefits Study. Based on these interviews, NMG ranked group insurers in six categories, ranging from operational management to technology.
Nationally, Equitable Life ranked either first or second in four of the six main categories:
Advisors in Ontario, in particular, scored Equitable Life very favourably. We ranked #1 overall in the province, finishing first in four of the six overall categories, including: Relationship Management, Operational Management, Underwriting and Claims Management and Technology.
“The fact that advisors regard us so highly in so many categories is a testament to our mutual status and our ability to focus exclusively on our clients and advisors,” said Marc Avaria, Senior Vice President of Group. “We are truly working together to build strong, enduring and aligned partnerships.”
“While we are happy with these results, we won’t rest on our laurels,” added Avaria. “We will continue to dedicate ourselves to providing our clients and advisors with a better benefits experience.”
Here are more of the highlights from this year’s results:
Nationally, we ranked first in all 10 subcategories in Operational Management, including:- Overall service to intermediaries,
- Overall service to plan sponsors,
- New quote process,
- Plan implementation,
- Renewal process,
- Information shared at renewal,
- Accuracy and timeliness of reporting and billing,
- Administration quality and responsiveness,
- Taking ownership and
- Management information quality and availability.
- Company relationship management,
- Ease of doing business,
- Account executive capability,
- Market knowledge,
- Visit/call quality,
- Effective coordination and
- Advice.
- Fairness and timeliness of disability claims (1st)
- Fairness and timeliness of health claims (2nd)
- Fraud management (2nd)
- Competitiveness of pooling charges (2nd)
- Group underwriting flexibility (3rd)
- Health and dental TLR competitiveness (3rd)
- Overall technology – Intermediary (2nd)
- Member experience (2nd)
- [pdf] Equitable GIF TFSA Application
- [pdf] Equitable GIF FHSA Application
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Easier group enrolment and more group benefits updates
Make enrolment easier for your clients with online plan member enrolment (OPME)
Enrolling new plan members can be overwhelming – for both you, your clients and their employees. It’s time-consuming to manually load new members and challenging to ensure they complete the necessary paperwork before the enrolment deadline.
Our Online Plan Member Enrolment (OPME) tool is available at no extra cost for all your Equitable Life clients and offers a more secure and efficient alternative to traditional paper enrolment. Using their computer or mobile device, employees can enrol in their benefits plan in just minutes.
The user-friendly tool allows plan members to easily enter all their enrolment information, including:- Dependent details
- Banking information for direct deposit of claim payments
- Details for coordination of benefits
- Beneficiary designation
The days of chasing plan members for their paper enrolment forms are gone. Once plan administrators enter a few employee details, our system automatically sends an email to each plan member, inviting them to enrol in their benefits program. And there will be no need for your clients to send reminders or follow up with employees about their benefits enrolment. It’s all done automatically.Support with using OPME
To learn more about the benefits of using OPME, check out our Online Plan Member Enrolment Flyer. We also encourage you to share more information with your clients: We also have helpful reference guides for plan members, to help them use the tool:- Online Plan Member Enrolment Quick Reference Guide
- myFlex Online Plan Member Enrolment Quick Reference Guide
Help your clients spend less time administering group benefits. Contact your Group Account Executive or myFlex Sales Manager to learn more about our online plan member enrolment.
Coming soon: A survey to help us serve your clients better*
We are committed to providing your clients and their plan members with industry-leading service. We’ve introduced several enhancements over the past year to make it easier to do business with us. And we’re continually looking for ways to improve.
This month, we will conduct a survey of your clients to help us understand how we can better serve them. Plan administrators will receive an email with a link to the survey, which will take between five and 10 minutes to complete.
Please encourage your clients to participate. Their feedback will be confidential, and their responses will help us improve our service and ensure we’re meeting their expectations. We will also allow them to provide their name so that we can follow up with them to address any concerns they’ve identified.
We know your clients’ time is valuable. So, each plan administrator who completes the survey will be entered into a random draw for a chance to win one of 3 prepaid gift cards for $200.
Improved mental assessment features for FeelingBetterNow®*
Mensante has enhanced its FeelingBetterNow® online platform to make it easier for plan members to assess the state of their mental health and talk to their health care provider about treatment options. FeelingBetterNow is part of our Equitable HealthConnector suite of wellness solutions and is available for an additional cost. It can help plan members easily identify if they are at risk for a number of common mental health issues, including depression, anxiety and substance abuse.Upgrades to the platform include:
- New features to help plan members better gauge their progress in the assessment.
- A printable Action Plan that plan members can share with their health care provider to initiate conversations about managing their mental health challenges.
- A new “follow-up” module to help plan members assess the care they’ve received from their health care provider and identify care gaps.
- An Assessment Outcome Page, which allows plan members to view their diagnostic risks across mental health disorders for a more holistic picture of their health.
Over-age dependants losing coverage?*
Your clients’ plan members may have dependants approaching the maximum age for eligibility under their group benefits plan. If so, members should be aware of their options for dependant coverage.Coverage for full-time students and dependants with disabilities
The dependants of your clients’ plan members may be eligible to continue their coverage under the current plan if:- The dependant is attending a post-secondary school full-time; or
- The dependant is disabled.
Coverage2go for over-age dependants
Dependants who aren’t eligible for continued coverage under the plan can apply for Coverage2go®, a month-to-month health and dental plan for individuals losing their group coverage.**
Coverage2go is affordable, reliable and allows the over-age dependants to choose the level of coverage and protection that suits their personal situation. With no medical questions required as long as they apply within 60 days of losing their coverage, your clients’ plan members can ensure that their over-age dependants have the coverage they need.
Plan members can receive a quote within minutes. Please direct your clients to Coverage2go on Equitable.ca to learn more.
**Quebec residents are not eligible for Coverage2go.Forfeiture reports for HCSAs and TSAs on EquitableHealth.ca*
As a reminder, your clients can access forfeiture reports for their Health Care Spending Account (HCSA) and Taxable Spending Account (TSA) usage on EquitableHealth.ca.HCSA summary by plan member
HCSA summary reports provide an overview of each plan member’s account activity and balances. These reports include the total amounts allocated, the amount claimed to date, the net balance, and the amount of funds that will be forfeited based on claims paid to date. Please note that plan members’ claim submissions will remain confidential and will not be viewable by the employer on this summary.
Your clients can provide each plan member with their HCSA summary, if they wish.HCSA account forfeiture by plan member
HCSA forfeiture reports detail the amount that each member will forfeit if they do not use it. The amount is based on claims that have been paid to date within the benefit year period.HCSA account totals by plan member
Your clients may wish to access the HCSA account totals reports, which reflect the information in each plan member’s HCSA summary report. For terminated employees, the Funds Available field will display as zero, regardless of the balance in the account when terminated.
At least three months before the end of the benefits period, your clients should remind their members to use their allocated HCSA and TSA amounts.
If your clients need help accessing these reports, they can reach out to their Regional Office Service team for assistance.
* Indicates content that will be shared with your clients.
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Equitable Life Group Benefits Bulletin – May 2021
In this issue:
- Graduating dependents losing coverage?*
- New Brunswick expands the use of biosimilars*
- Proposed changes to federal recovery and EI benefits*
- Removal of plan administrator access to update plan member banking*
- BioScript recognized as one of Canada’s Best Managed Companies*
Graduating dependents losing coverage?
Let plan members know about Coverage2go
As we reach the end of spring, some of your clients’ plan members may have dependents who are graduating from university or college and will no longer be eligible for coverage under the benefits plan.
Fortunately, we offer 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 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 Coverage2goNew Brunswick expands the use of biosimilars
The New Brunswick government recently announced that it will be implementing a biosimilar transition program.
Patients using originator biologic drugs for diseases such as inflammatory arthritis, inflammatory bowel disease, diabetes and psoriasis, will have until November 30, 2021 to switch to the biosimilar version of their medications in order to maintain coverage under the province’s public drug plans. This process will be completed in consultation with the patients’ physicians.
Biosimilars are highly similar to the drugs they are based on and Health Canada considers them to be equally safe and effective for approved conditions.
Equitable Life® actively monitors and investigates all biosimilar policy changes and the ongoing evolution of biosimilar drugs entering Canada. We will keep you informed of any impact on private drug plans and how we are responding.Proposed changes to federal recovery and EI benefits
In its recent 2021 budget, the federal government proposed a variety of changes to its benefit programs.
The proposed changes include providing up to 12 additional weeks of the Canada Recovery Benefit to a maximum of 50 weeks. The first 12 weeks of this benefit would be paid at $500 per week and the remaining eight weeks at $300 per week.
Multiple changes have also been proposed to make Employment Insurance (EI) more accessible to Canadians. The changes include: maintaining uniform access to EI benefits across all regions, supporting multiple job holders and those who switch jobs by ensuring that all insurable hours and employment count towards their eligibility, and simplifying many rules around EI to ensure Canadians can receive benefits sooner. It has also been proposed that the regular EI benefits be extended to no later than November 20, 2021, if needed.
We are analyzing the impact these changes may have to disability benefits. We will provide more details later in the year.Removal of plan administrator access to update plan member banking
In early June, plan administrators will no longer be able to update banking information for their plan members on EquitableHealth.ca after their initial enrolment. This change has been made to allow plan members to have full control over where they want their claim payments deposited.
Plan members can update their banking information online through their plan member web portal or through the EZClaim mobile app. They will continue to be notified via email if and when they make any changes.BioScript Solutions recognized as one of Canada’s Best Managed Companies
Congratulations to our partner, BioScript Solutions, for being recognized as one of Canada’s Best Managed Companies of 2021 by Deloitte.
We have partnered with BioScript since 2016 for our Specialty Drug Preferred Pharmacy Network (PPN). This partnership offers cost savings while providing comprehensive, best-in-class patient care.
BioScript is one of Canada’s leading specialty pharmacies and recently celebrated its 20th anniversary.
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