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Update: Employment Insurance (EI) Sickness Benefit Extension
As it proposed in its 2022 Budget, the federal government has confirmed it is extending the Employment Insurance (EI) Sickness Benefits period from 15 weeks to 26 weeks later this year. The official implementation date and details have not yet been confirmed by the government and we will share further details once they are available. In the meantime, here’s what you need to know.
We will not require or implement any changes to our disability plan designs based on this extension. However, plan sponsors may wish to amend their short-term disability (STD) and long-term disability (LTD) plans and policies to align with the new 26-week EI period.Impact to short-term disability (STD) benefits integrated with EI
Plan sponsors with EI-integrated STD may wish to adjust their benefits to line up with the new 26-week extension.
Impact to plans with no STD benefits
For plan sponsors who do not offer STD, they have the option of adjusting their LTD plans to the new 26-week elimination period if members claim EI prior to LTD. This adjustment would help to avoid the plan member receiving disability and EI payments at the same time and potentially being required to return funds due to overpayment.Considerations for plan sponsors
Plan sponsors who amend their STD or LTD policies to align with the new 26-week EI period should note that there may be inadvertent delays to their employees’ return to work. While collecting EI, injured or ill employees do not benefit from our early intervention services or rigorous claims management practices that could help them get back to work sooner. So, by delaying the availability of STD or LTD coverage, the advantages that these programs are intended to provide could also be delayed.Impact to Premium Reduction Program (PRP)
The Premium Reduction Program (PRP) allows employers with eligible short-term disability plans to pay lower EI premiums. The eligibility criteria have not changed at this time. The government plans to review the PRP in 2024.Questions
If you have questions about these changes or what they mean for your clients’ disability plans, please contact your Group Account Executive or myFlex Sales Manager.
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Dialogue Virtual Healthcare now available to add to Equitable Life benefits plans
We’re pleased to announce we are partnering with Dialogue, Canada’s leading virtual health provider, to offer unlimited and on-demand virtual access to primary healthcare practitioners.
Virtual Healthcare is the latest addition to our HealthConnector suite of health and wellness services. It is available to add to all Equitable Life benefits plans for an additional cost as of July 1, 2023.Features of Dialogue Virtual Healthcare
Available 24/7, 365 days a year, Dialogue Virtual Healthcare provides access to unlimited non-urgent medical care for a wide range of health concerns. Plan members get fast access to the largest, most experienced and bilingual medical team in Canada for non-urgent medical issues. They also benefit from in-app prescription renewals and refills, personalized follow-ups after every consultation, and concierge-level navigation support for all referrals to in-person specialists when needed.
Dialogue’s industry-leading platform provides an all-in-one patient journey to address health issues, reducing long wait times and time away for doctor appointments. Plan members and their families can access Dialogue Virtual Healthcare through the secure web portal or mobile app. The Dialogue medical team includes doctors, nurse practitioners and nurses. Plan members can use the service even if they’re already receiving care from a family doctor.
For your clients
Benefits of Virtual Healthcare
By providing access to Virtual Healthcare, plan sponsors can help to:-
Drive employee engagement;
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Reduce absenteeism related to in-person medical appointments;
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Manage chronic health issues;
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Attract and retain top talent; and
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Build a healthier workforce.
By providing easier access to primary healthcare practitioners, Virtual Healthcare can offer extra health and wellness support for plan members. It also supports members that may experience barriers to accessing in-person healthcare, such as:-
Living in a remote location;
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Work or family obligations during standard medical clinic hours;
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Mobility challenges related to a disability; and
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Transportation challenges.
Click the link to learn more about Dialogue Virtual Healthcare : Welcome to Dialogue!Questions?
To learn more about how your clients can add Virtual Healthcare to their benefits plan, please contact your Group Account Executive or myFlex Sales Manager. -
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Announcing Equitable Life's National Biosimilar Program
Beginning March 1, 2024, we are expanding our biosimilar switch program nationally** to protect all our clients and to make our coverage consistent across Canada.
Our national biosimilar initiative will simplify drug plan coverage, replacing our provincial programs with one program across the country.
Why now?
Over the past few years, most provinces have introduced policies to delist some originator biologic drugs. They require most patients to switch to biosimilar versions of those drugs to be eligible for coverage under their public drug plans. Soon, it is expected that all provincial drug plans will cover only biosimilars.
In response, we have implemented biosimilar switch initiatives in BC, Alberta, Saskatchewan, Ontario, Quebec, New Brunswick and Nova Scotia to align with these provincial changes. Our initiatives are designed to protect our clients from additional drug costs that may result from these government policies while providing access to equally safe and effective lower cost biosimilars.
How will this affect clients’ drug plans?
Because we have already introduced biosimilar switch initiatives in most provinces, the impact of this change will be minimal. It will primarily affect plan members in provinces or territories where we haven’t already required the switch to biosimilars, and plan members who are taking biosimilars that were not originally included in the switch initiative for their province.
Regardless of where they live, plan members across Canada 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. Plan members already taking the originator biologic will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable plan. We will support their transition with education, personalized communication, and resources.
Will this change affect clients' rates?
Any cost savings associated with the change will be factored in at renewal.
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.
What is the difference between biologics and biosimilars?
Advance notice
We will be communicating with affected claimants in early December to allow them ample time to change their prescription and avoid any interruptions in their treatment or their coverage.
If you have any questions about this change, please contact your Group Account Executive or myFlex Account Executive.
**Excludes plan members in Quebec who participate in a separate provincial program. -
This year’s Registered Retirement Savings Plan deadline is March 3, 2025.
Have you talked to clients about their Registered Retirement Savings Plan (RRSP) contributions yet? Equitable® offers RRSP products to meet clients’ needs including:
• Daily/Guaranteed Interest Account
• Pivotal Select™ Segregated Funds
• Investment Class (75/75)
• Estate Class (75/100)
• Protection Class (100/100)
These products offer protection and flexibility that clients need, with the tax savings and benefits of a RRSP. Encourage clients to contribute to their RRSP early. And make RRSP contributions a financial priority each year!
What’s new
The Home Buyer’s Plan is offering temporary repayment relief for qualifying withdrawals from their RRSP. This means that clients can defer the start of the repayment period by an additional three years when they make a first qualifying withdrawal between January 1, 2022 and December 31, 2025. This means the 15-year repayment period would start in the fifth year after the year in which a first withdrawal was made. For example, if you made your first qualifying withdrawal in 2022, your first year of repayment will be 2027.1
Tools and materials to help you start the conversation
Often clients have good intentions about saving for retirement. However, even the best intentions need an action plan. As a trusted advisor, you can help clients see the value in making a RRSP a financial priority. We have tools and marketing materials to help you start the conversation. Show clients why an Equitable RRSP can help them to achieve their financial goals in retirement.
Equitable’s advisor toolbox, available on EquiNet®, includes Product News, Prospecting Letters, Forms, Marketing Materials, Case Studies, Articles and Investment Calculators.
1 www.canada.ca/en/revenue-agency/services/tax/individuals/topics/rrsps-related-plans/what-home-buyers-plan/repay-funds-withdrawn-rrsp-s-under-home-buyers-plan.html
® or ™ denotes a trademark of The Equitable Life Insurance Company of Canada.
Posted February 7, 2025
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Changes to coverage of Humira in BC
BC Pharmacare recently announced it is adding Humira to the list of drugs included in its ongoing initiative to switch patients to biosimilar versions of high-cost biologics. Patients taking Humira for most conditions will be required to switch to a biosimilar version of the drug by Oct. 7, 2021 to maintain coverage under the public plan.
Biologics are drugs that are engineered using living organisms like yeast and bacteria. The first version of a biologic developed is also known as the “originator” biologic. Biosimilars are also biologics. They are highly similar to the originator biologic drugs they are based on, and Health Canada considers them to be equally safe and effective for approved conditions.
How we are responding to protect our clients
To help prevent this change from resulting in additional costs for our clients’ drug plans, while still providing plan members with access to safe and effective medications, we will no longer cover Humira for plan members in BC. Effective Oct. 7, 2021, claimants currently taking Humira will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable Life plan.
We will be communicating this change to plan administrators later this week. And we will be communicating with affected claimants in early August to allow ample time to change their prescription and avoid any interruptions in their treatment or their coverage.
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
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December 2022 eNews
Update: EI Sickness Benefit Extension confirmed for Dec. 18, 2022*
The federal government confirmed on Nov. 25, 2022, that it is extending the Employment Insurance (EI) Sickness Benefits period permanently from 15 weeks to 26 weeks. The change takes effect on Dec. 18, 2022.
Equitable Life will not require or implement any changes to our disability plan designs based on this extension. However, plan sponsors may wish to amend their short-term disability (STD) and long-term disability (LTD) plans and policies to align with the new 26-week EI period.
If your clients choose to amend their plan design in response to this extension, we have created an overview of how amendments may affect common plan design scenarios. Click here to learn more.
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager.
QDIPC updates terms and conditions for 2023*
Every year, the Quebec Drug Insurance Pooling Corporation (QDIPC) reviews the terms and conditions for the high-cost pooling system in the province.
Based on its latest review, QDIPC is revising its pooling levels and fees for 2023 to reflect trends in the volume of claims submitted to the pool, particularly catastrophic claims:
We will apply the new pooling levels and fees to future renewal calculations that involve Quebec plan members.
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager.
*Indicates content that will be shared with your clients
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February 2020 Advisor eNews
In this issue:
Provincial biosimilar update
Legislative changes for Alberta’s Coverage for Seniors program
Coming soon: enhancements to Equitable EZClaim® Online
Provincial biosimilar update
Alberta Biosimilar Initiative
On December 12, 2019, the Alberta government introduced the launch of the Alberta Biosimilar Initiative. This program will require patients using several originator biologic drugs to switch to a biosimilar, and patients using a non-biologic complex drug (NBCD) to switch to its subsequent entry version before July 1, 2020 in order to maintain coverage.
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” drug. Biosimilars 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.
Alberta Health will initially cover both the originator and biosimilar or subsequent entry version of a NBCD drug as patients start the switching process.
The following table outlines the affected originator drugs, their biosimilars or subsequent entry, and the conditions affected by the program.
Biosimilar Drug Originator Biosimilar/Subsequent Entry Indications Affected etanercept Enbrel Brenzys Ankylosing Spondylitis
Rheumatoid ArthritisErelzi Ankylosing Spondylitis
Psoriatic Arthritis
Rheumatoid Arthritisinfliximab Remicade Inflectra
RenflexisAnkylosing Spondylitis
Plaque Psoriasis
Psoriatic Arthritis
Rheumatoid Arthritis
Crohn’s Disease
Ulcerative Colitisinsulin glargine Lantus Basaglar Diabetes (Type 1 and 2) Filgrastim Neupogen Grastofil Neutropenia pegfilgrastim Neulasta Lapelga Neutropenia glatiramer* Copaxone Glatect Multiple Sclerosis *Glatiramer is a non-biologic complex drug where the originator is Copaxone and the subsequent entry is Glatect.
Equitable Life is actively investigating the benefit, risk and appropriate plan changes associated with this new policy on private drug plans and will keep you informed.
For more information about the Alberta Biosimilars Initiative, consult the Alberta government website.
British Columbia
In 2019, BC Pharmacare introduced a Biosimilars Policy that impacted coverage of three biologic drugs – Remicade, Enbrel and Lantus. As of November 25, 2019, these drugs were no longer eligible in BC for most conditions for which lower cost biosimilar versions are available. Patients in the province with these conditions were required to switch to biosimilar versions of these drugs in order to maintain their coverage.
The second phase of the BC Biosimilar Policy takes effect March 6, 2020 when Remicade will be delisted for Crohn’s Disease and Ulcerative Colitis. Patients in the province with these conditions will be required to switch to Inflectra or Renflexis in order to maintain their coverage.
Biosimilar Drug Originator Biosimilar Indications Affected infliximab Remicade Inflectra
RenflexisCrohn’s Disease
Ulcerative ColitisWe have communicated with the affected plan members, informing them of the need to switch medications. If plan members have any questions or concerns, our Customer Care team is here to help and support them through the transition.
If you have any questions about this policy, please contact your Group Account Executive or myFlex Sales Manager.
Ontario
In November 2019 Ontario Minister of Health Christine Elliot indicated that the government was planning to launch consultations to explore solutions in managing biologics.
Equitable Life will continue to monitor these developments and keep you informed of any impact on private drug plans.
Legislative changes for Alberta’s Coverage for Seniors program
The government of Alberta has announced that as of March 1, 2020, seniors’ family members (such as spouses and dependents) who are younger than 65 will no longer be covered by the provincial Coverage for Seniors program. Albertans 65 years of age and older will continue to be covered under the provincial plan.
Equitable Life plan members and their dependents will continue to be covered under the parameters of their group benefits plan.
For more information, please see the Alberta Seniors Health Benefits website.
Coming soon: enhancements to Equitable EZClaim® Online
Faster vision claims processing and payment
Equitable Life will soon provide real-time processing of vision claims submitted via EZClaim Online.
This means plan members will be able to find out the status of their vision claim almost instantaneously. And, for approved claims, they will receive payment even sooner – often in as little as 24 hours.
In order to allow for instantaneous processing and faster payment, plan members will be prompted to enter some additional information including the practitioner’s name, the date of the expense, the type of expense and amount of the expense when submitting their claims for these services.
Equitable Life plan members can submit all vision claims via EZClaim, including coordination of benefits and Health Care Spending Account claims.
This enhancement will be coming to our EZClaim Mobile app in the coming months.
New printable claims extract
As part of our ongoing efforts to improve customer experience for plan members, we will also offer a claims extract in a printable format within the plan member site. Plan members will be able to select a date range and claimant, then generate and download a detailed list of health and dental claims. This is a helpful way to keep track of claims, especially when reviewing them in preparation for income tax filing.
Once these enhancements are live you will be notified in an eNews, and an announcement will be posted on the plan member section of EquitableHealth.ca.
Elimination of Out-of-Country Travellers Program in Ontario
Effective January 1, 2020, the Ontario government eliminated OHIP coverage for emergency services for Ontarians travelling outside of Canada.
Previously, the Out-of-Country Travelers Program provided some reimbursement for services required to treat conditions that are acute, unexpected, arose outside Canada and require immediate treatment. The program covered between $200 and $400 per day for inpatient services and $50 per day for outpatient and doctor services.
For groups who have out-of-country coverage from Allianz, this change will not impact the cost to your plan members, or the process plan members follow in the event of an emergency while travelling.
Plan members should still call Allianz in the event of an out of country emergency. Allianz will deal with their claim as usual and will now pay for the portion of the claim previously paid by OHIP. Plan members will not have any additional out-of-pocket costs.
We will be sharing this information with plan members as a news item on our plan member website, equitablehealth.ca.
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February 2023 eNews
Responding to Nova Scotia’s biosimilar switch initiative
We are changing coverage for some biologic drugs in Nova Scotia 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.Nova Scotia’s provincial biosimilar initiative
Announced in February 2022, the Nova Scotia Biosimilar Initiative ends coverage of seven biologic drugs for residents enrolled in Pharmacare programs.
Pharmacare patients in the province using these drugs will be required to switch to biosimilar versions of these drugs by February 3, 2023, in order to maintain their Nova Scotia Pharmacare 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 Nova Scotia for most biologic drugs included in the provincial initiative.
Beginning June 1, 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.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 Nova Scotia plan members can submit a policy amendment. Amendments must be submitted no later than April 1, 2023. Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for Nova Scotia plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.
Groups that choose to maintain coverage of these originator biologics for existing claimants will also maintain coverage for any originator biologics that we subsequently add to our Nova Scotia biosimilar initiative.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.Communicating this change to plan members
We will inform any affected plan members in April 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 Nova Scotia includes more biologic drugs in its biosimilar initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.
Changes to New Brunswick drug interchangeability rules
We are introducing changes to help ensure that your clients with voluntary or mandatory generic pricing for their drug plans will benefit more from the cost savings of these two features, regardless of the province where the drugs are dispensed.
Currently, when determining whether a lower-cost alternative is available for a brand-name drug, most insurers only consider drugs that the provincial drug plan identifies as interchangeable.
However, the public drug plan in New Brunswick does not identify a drug as interchangeable if the drug is not listed on its formulary – even if Health Canada has deemed the drug interchangeable.
As a result, plans with mandatory or voluntary generic pricing have continued to reimburse some drugs in New Brunswick based on the cost of the brand-name drug, even if a lower-cost generic alternative is available.
Effective March 20, 2023, if your clients have drug plans with mandatory or voluntary generic pricing, we will adjudicate any drug claims in New Brunswick using the lowest cost alternative that Health Canada approves as bioequivalent. This will occur even if the public drug plan has not identified the drug as interchangeable.
To benefit from this more robust drug plan control, plan sponsors must have mandatory or voluntary generic pricing in place.
For more information about this change or about implementing mandatory or voluntary generic pricing for your clients, please contact your Group Account Executive or myFlex Sales Manager.
New template: plan members eligible for additional coverage
Often, based on salary, some plan members may become eligible to apply for extra Life, Accidental Death & Dismemberment (AD&D), Short Term Disability or Long Term Disability coverage. If this occurs, your clients receive a notification from Group Benefits Administration. We have now developed a template that your clients can provide to applicable plan members if they become eligible for extra coverage. The template makes it simpler for your clients to pass on these details to their plan members efficiently.
The new template is available for download under the Quick Links section of EquitableHealth.ca. It is a fillable PDF form that your clients can complete and provide to their plan members when necessary. The document is called Over the Non-Evidence Limit for Plan Members Notification.
If you have any questions about the template, please contact your Group Account Executive or myFlex Sales Manager. -
Equitable Life creates guide to accessing virtual healthcare at no cost
With many health clinics closed and the healthcare system under strain, people are looking to access a doctor and other health providers virtually.
To make it easier for plan members, we’ve created the Guide to Accessing Virtual Health Care Services on the plan member section of EquitableHealth.ca. This online resource provides information about and links to a range of virtual health services they need to take care of their health and the health of their family during these challenging times.
The Guide also indicates which services can be accessed for free. In some provinces, online doctor visits are now covered by the public health plan, so there’s no cost to the patient to access them as long as they provide their valid provincial health card. In other provinces, the nominal fee can be claimed on a Health Care Spending Account.
We will continue to update the Guide as more virtual healthcare providers and services become available.