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1. Equitable Life Group Benefits Bulletin - September 2022

   Homewood Health launches Sentio, an upgraded iCBT platform

   Equitable Life’s mental health partner, Homewood Health, has launched Sentio, an upgraded platform for Internet-based cognitive behavioural therapy (iCBT). This self-directed platform is now available to all Equitable Life clients, and it replaces Homewood’s previous iCBT platform, i-Volve.
   
   Sentio Self-Directed iCBT is a comprehensive digital cognitive behavioural therapy platform. Developed by Homewood’s mental health experts, it is an action-oriented solution for plan members, giving them practical resources and activities to help with their depression, anxiety and overall mental health challenges.
    
   Available as a standalone app, on mobile, tablet and desktop, Sentio contains over 20 unique treatment goals for issues like stress management, improving sleep, managing depressive thoughts, and coping with panic. Users can work through treatment goals in any order, at their own pace. It also includes tools and resources to help plan members build skills and change their thought patterns. 

   Sentio iCBT benefits

   Sentio integrates seamlessly with Homewood Pathfinder so that users can easily locate and take advantage of the iCBT activities available. Sentio also includes a number of unique features:
   • More interactive features and activities to help plan members build valuable mental health skills
   • Integrated symptom measurement and progress tracking
   • Interactive multimedia learning and cognitive exercises to enhance learning
   • Progress, learnings, and exercises that have been accessed are available to be re-accessed for 12 months 
   Access to i-Volve will end 30 days after your clients received access to Sentio, but plan members can complete any in-progress sessions until then.
   
   Please contact your Group Account Executive or myFlex Sales Manager if you have any questions.
    

   Streamlining disability claims with Opifiny

    Equitable Life is partnering with Opifiny to provide a quicker and more seamless disability claims experience.
    
   Opifiny is an online platform that streamlines the disability claims process for consulting physicians, benefits plan sponsors, and disability plan members. Equitable Life will be using Opifiny for ongoing disability claims management, modernizing the process of gathering medical assessments and information.
    
   Disability claims frequently involve several instances of correspondence between Equitable Life and the plan member’s medical team. By using the secure platform, health care professionals can access, respond to and process medical insurance requests easily from any device. They can typically complete administrative tasks associated with disability claims in a quarter of the time. The platform is secure and protects the privacy of their patients’ confidential information.
    
   By digitizing and modernizing the claims management process for doctors, Equitable Life will have faster access to higher quality claims information. For some claims, using Opifiny may enable Equitable Life to help plan members safely return to work sooner.
    

   Reminder: Obtaining plan member signatures on all administration forms

   Please remind your clients that plan members must sign all administration forms, including enrolment forms, benefits change forms, and beneficiary designation forms. Once completed, a plan administrator can keep the form or send it to us. We are not able to accept a beneficiary designation that has not been signed by the plan member. Having appropriately signed forms helps to ensure that any life insurance claims are paid to the intended recipients.
   
   For your clients’ convenience, forms can be signed electronically using one of our approved vendors, which include DocuSign, BambooHR, Adobe Sign, and many more.
   
   If you have questions about providing signed forms, please contact your Group Account Executive or myFlex Sales Manager.
    

   Correction: Coverage for full-time students and dependents with disabilities

   In our August edition of eNews, we provided incorrect information about benefits coverage options for over-age dependents. We indicated that over-age dependents who are full-time students may continue to be eligible under the plan member’s benefits plan if they are studying in their home province. However, attending a post-secondary institution in their home province is not a requirement for continued eligibility. Dependents who are full-time students may continue to be eligible for coverage regardless of where in Canada they are attending post-secondary education.
   
   If your clients have any questions about extending coverage for over-age dependents that are full-time students, please notify them of this error.
    
   We apologize for any inconvenience or confusion this may have caused.
   
   
    
2. Policy endorsement: Contracts and group benefits plan booklet updates related to BC PharmaCare Biosi

   As we announced in the June 2019 issue of eNews, BC PharmaCare recently introduced a new Biosimilars Initiative that ends coverage of three biologic drugs, including Remicade, Enbrel, and Lantus. These drugs will no longer be eligible in British Columbia for most conditions for which lower-cost biosimilar versions are available. Patients in the province with these conditions will be required to switch to biosimilar versions of these drugs by Nov. 25, 2019 in order to maintain their coverage under BC PharmaCare.
    
   The following table outlines the affected originator drugs and their biosimilars.
    

   Drug	Originator	Biosimilar
   etanercept	Enbrel®	Brenzys® Erelzi™
   infliximab	Remicade®	Inflectra® Renflexis®
   insulin glargine	Lantus®	Basaglar™

    
   Biologics are drugs that are engineered using living organisms, such as yeast and bacteria. Biosimilars are highly similar to the originator drugs they are based on and most have been shown to have no clinically meaningful differences in safety or efficacy.
    
   To ensure this provincial change doesn’t result in your clients' plans paying additional drug costs, we are aligning our drug eligibility for these three biologic drugs with that of BC PharmaCare.
    
   To facilitate this change, we are amending some of the wording in our contracts and booklets, effective Oct. 1, 2019. Below are links to the Endorsement to the Master Policy and the Summary of Master Booklet Wording Changes for those amendments. Please download and save these policy endorsement documents for your files.
    
   In addition, please remind your clients to provide their plan members with a copy of the Summary of Master Booklet Wording Changes. The next time your clients amend their benefits plans, the updated wording will be included in their group benefits plan booklets

   DOWNLOAD ENDORSEMENT TO THE MASTER POLICY

   DOWNLOAD SUMMARY OF MASTER BOOKLET WORDING CHANGES

   As of Nov. 25, 2019, Remicade and Enbrel will no longer be eligible for BC plan members with conditions for which lower-cost biosimilar versions of the drugs are available. These plan members will be required to switch to the biosimilar versions of these drugs in order to maintain eligibility on the Equitable Life drug plan.
    
   We will be communicating with affected claimants in the coming weeks to allow them ample time to change their prescription and avoid any interruptions in their treatment or their coverage.
    
   We intend to take a similar approach to Lantus. However, we are still investigating the options to implement this change. We will be communicating with you in the coming weeks to confirm our approach for this drug.
    
   If you have any questions about this change, please contact your Group Marketing Manager or myFlex Sales Manager.
    
   
   ^® and ^™ denote trademarks of their respective owners

3. 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.
    
4. 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. Benefits of Virtual Healthcare For your clients By providing access to Virtual Healthcare, plan sponsors can help to: Drive employee engagement; Reduce absenteeism related to in-person medical appointments; Manage chronic health issues; Attract and retain top talent; and Build a healthier workforce. For their plan members 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; Work or family obligations during standard medical clinic hours; Mobility challenges related to a disability; and Transportation challenges. Learn more about bringing Dialogue Virtual Healthcare to your clients 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.

5. 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.

   
   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.
    

   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. 
6. 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
    
7. About
8. 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.
    
9. 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
   
   
   
    
10. 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 Arthritis
    		Erelzi	Ankylosing Spondylitis Psoriatic Arthritis Rheumatoid Arthritis
    infliximab	Remicade	Inflectra Renflexis	Ankylosing Spondylitis Plaque Psoriasis Psoriatic Arthritis Rheumatoid Arthritis Crohn’s Disease Ulcerative Colitis
    insulin 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 Renflexis	Crohn’s Disease Ulcerative Colitis

    We 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.