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Equitable Life Group Benefits Bulletin – October 2020
In this issue:
- Group benefits enrolment just got a lot easier*
- Critical Illness added to myFlex Benefits® selection tool**
- ASO dental available down to 3 lives
- QDIPC updates terms and conditions for 2021*
*Indicates content that will be shared with your clients
**Indicates content that will be shared with myFlex Benefits groups onlyGroup benefits enrolment just got a lot easier*
Our Online Plan Member Enrolment tool now makes it simple to add new employees to the benefits plan.
Enrolling new plan members can be overwhelming – for both you, your clients and their employees. It’s challenging to ensure plan members complete the necessary paperwork before the enrolment deadline, and time consuming to manually load new members.
That’s why we’re updating our plan member enrolment experience. Beginning November 2nd, 2020, all Equitable Life groups will be able to easily enrol new employees in the benefits plan with our Online Plan Member Enrolment Tool.
Benefits of Online Plan Member Enrolment
Our Online Plan Member Enrolment tool offers a more secure and efficient option to traditional paper enrolment. Employees are able to enrol in their benefits plan in just minutes from their computer or mobile device.
The user-friendly interface was built with the plan member in mind. They can easily enter all their enrolment information, including dependent details, banking information for direct deposit of claim payments and details for coordination of benefits. They can even designate their beneficiary electronically.
The online enrolment tool also lessens the effort for plan administrators to onboard new hires. The tool reduces errors and rework that can occur due to spelling mistakes or missing information on paper forms. And the days of chasing plan members for their paper enrolment forms are gone. Once they enter a few employee details, our system will automatically send out an email to each plan member, inviting them to enrol in their benefits program. And there will be no need to send reminders or follow up with employees about their benefits enrolment. It’s all done automatically.
Online plan member enrolment is available to all traditional and myFlex Benefits plan administrators with update access beginning November 2nd, 2020. Plan administrators just choose “New” from the “Certificate” view in EquitableHealth.ca to get started.
This enhancement is for plan administrators who have update access on EquitableHealth.ca. If your clients are not sure if they have update access, they can contact their Equitable Life Client Relationship Specialist or myFlex Benefits Team for support.
Learn More
We’ve created Online Plan Member Enrolment User Guides to support your clients and their plan members with this new tool:
- Online Plan Member Enrolment 1-page flyer
- Plan Member Online Plan Member Enrolment Quick Reference Guide
- myFlex Plan Member Online Plan Member Enrolment Quick Reference Guide
We’re also offering a series of webinars to help your clients learn about Online Plan Member Enrolment. Plan administrators will receive an invitation with links to register for the time that best suits their schedule.
Help your clients spend less time administering group benefits. Contact your Group Account Executive or myFlex Sales Manager to learn more about our enhanced online plan member enrolment.
Critical Illness added to myFlex Benefits selection tool*
For many employers, mandatory Critical Illness (CI) coverage is an important part of their group benefits package. It provides proactive protection against life-altering illness, helping give plan members and their families a sense of security.
While CI is available on myFlex Benefits plans, it was not built into our benefits selection tool since there is no action required by the plan member.
Beginning November 2nd, 2020, we are adding a CI page to the myFlex Benefits selection tool that appears when this coverage is included as part of the plan. There are no options to choose – plan members simply review their CI coverage and carry on with the benefits selection process. It keeps the process smooth, while ensuring plan members fully appreciate their employer’s contributions.
Adding CI to the benefits selection tool also simplifies the budgeting process for employers. Now that CI is included in the selection tool, employers no longer need to break out the amount billed for CI from their contribution per employee when loading flex allocations.
To learn more about our myFlex Benefits selection tool or Critical Illness coverage for myFlex Benefits, contact your myFlex Sales Manager.
ASO dental available down to 3 lives
Beginning November 2nd, 2020, groups with as few as three full-time employees will be able to self-insure their Equitable Life dental benefits with an Administrative Services Only (ASO) funding arrangement.
Currently, dental benefits are only available on an ASO basis for groups with 20 lives or more.
In an ASO arrangement, Equitable Life administers the benefits plan but does not insure it. The plan sponsor pays for all eligible claims, as well as the expenses of administering the plan.
Why ASO?
Choosing an ASO funding arrangement allows plan sponsors to save on premiums. With a traditional insured funding arrangement, a portion of every premium dollar includes a charge for the risk that the insurer is assuming to cover the claims.
With an ASO arrangement, the plan sponsor assumes all risk, so they avoid the risk charge. And since dental claims are usually more predictable than other benefits, there is typically less risk involved in covering those claims.
For more information, contact your Group Account Executive or myFlex Sales Manager.
QDIPC updates terms and conditions for 2021*
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 2021 to reflect trends in the volume of claims submitted to the pool, particularly catastrophic claims.
Size of group (# of certificates) Threshold per certificate 2021 Annual factor (without dependents) Annual factor (with dependents) Fewer than 25 $8,000 $251.00 $691.00 25 - 49 $16,500 $165.00 $455.00 50 - 124 $32,500 $94.00 $258.00 125 - 249 $47,500 $68.00 $187.00 250 - 499 $72,000 $49.00 $135.00 500 - 999 $95,000 $40.00 $111.00 1,000 - 3,999 $120,000 $35.00 $95.00 4,000 - 5,999 $300,000 $16.00 $44.00 6,000 and over Free market - Groups not subject to Quebec Industry Pooling Free market - Groups not subject to Quebec Industry Pooling Free market - Groups not subject to Quebec Industry Pooling We will apply the new pooling levels and fees to future renewal calculations that involve Quebec plan members.
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Equitable Life Group Benefits Bulletin – February 2022
In this issue:
- Update: Alberta biosimilar coverage changes*
- Preferred Biosimilar Program*
- Responding to Quebec’s biosimilar policy*
- Dental fee guide updates*
- Reminder: Review manual allocations for HCSAs and/or TSAs*
- Mental health resources for plan members*
Update: Alberta biosimilar coverage changes*
In 2022, Alberta’s provincial drug plan is adding four originator biologics to its Biosimilar Initiative. It has ended or will end provincial coverage of these drugs for some or all conditions, as follows:
Four originator biologics added to Alberta Biosimilar Initiative- Lovenox: Jan. 10, 2022
- Humalog: Feb. 1, 2022
- NovoRapid: April 1, 2022
- Humira: May 1, 2022
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.
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 these originator biologic drugs for plan members in Alberta.
Effective May 1, 2022, claimants currently taking these drugs will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable Life plan.
This is a continuation of the Alberta biosimilar switch program we launched last March, when the province first introduced its Biosimilar Initiative.
Do my clients need to take any action?
No action is required by plan sponsors. Plan members taking these targeted originator biologics will be contacted directly to allow them ample time to transition to a biosimilar. Any cost savings associated with the change will be factored in at renewal.
Groups that opted out of the biologic coverage changes we made last March will automatically be opted out of these coverage changes, as well as any future changes to our Alberta biosimilar switch program. This means that their drug plans will continue to provide coverage to existing claimants for any originator biologics we stop covering as part of our biosimilar program.
Advisors with clients who wish to opt out of our Alberta biosimilar program, or who previously opted out and want to opt back in, should speak to their Group Account Executive or myFlex Sales Manager.
Communication to plan members
We will be communicating these coverage changes with affected claimants in early March to allow them ample time to change their prescriptions and avoid any interruptions in their treatment or their coverage. Thus far, the transition to biosimilars, has been smooth and continues to be successful.
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 also biologics. 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.Preferred Biosimilar Program*
As part of our ongoing efforts to help ensure the sustainability of your clients’ drug plans, we continue to engage in strategic partnerships with pharmaceutical manufacturers.
We are pleased to announce a partnership to make Hyrimoz our preferred biosimilar for Humira. This partnership will generate additional savings for plan sponsors.
Plan members will still have the choice to use Humira biosimilars other than Hyrimoz. However, in the absence of alternative sources of reimbursement, this may increase their out-of-pocket amount.
The Preferred Biosimilar Program will take effect March 1, 2022 for all new claimants across Canada who start using a Humira biosimilar. It will take effect May 1 for existing claimants in Alberta who switch to a Humira biosimilar, to align with changes to the provincial plan.
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.Responding to Quebec’s biosimilar policy
Last year, the Quebec government announced it is phasing out coverage of biologic drugs. Beginning April 13, 2022, patients in Quebec using originator biologics will be required to switch to the corresponding biosimilar covered on the province’s public plan in order to maintain coverage.
The following populations are excepted from this new policy:- Pregnant women, who should be transitioned to biosimilars in the 12 months after childbirth.
- Pediatric patients, who should be transitioned to biosimilars in the 12 months after their 18th birthdays.
- Patients who have experienced two or more therapeutic failures while being treated with a biologic drug for the same chronic disease.
We are actively investigating the impact of this new policy on private drug plans in Quebec. We plan to implement further enhancements to our biosimilar programs in Quebec later this year to help prevent this change from resulting in additional costs for our clients’ drug plans. We will provide more details in the coming months.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 2022.*
Dental fee guide increases over 2021*
*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.Province/Territory Average Fee Increase Alberta 3.9% British Columbia 7.35% Manitoba 5.79% New Brunswick 5.9% Newfoundland and Labrador 5% Nova Scotia 7.05% Northwest Territories 3% Nunavut 3.1% Ontario 4.75% Prince Edward Island 4.75% Quebec 5% Saskatchewan 5.99%
Reminder: Review manual allocations for HCSAs and/or TSAs*
If your client’s Health Care Spending Account (HCSA) and/or Taxable Spending Account (TSA) has manual allocations, they need to allocate these amounts to plan members each year. Please review all your plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year.
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”
- Select “Reports”
- Select “New”
- Select “Next”
- Select “HCSA” or “TSA Totals by Plan Member”
- Select “Next”
- Enter end date of “12/31/2020”
- Select “Next”
- Select “Finish”
- View “Report”
Mental health resources for plan members*
As the COVID-19 pandemic continues to evolve, many Canadians are experiencing increased levels of stress, anxiety, and depression. Through our partnership with Homewood Health®, all of our clients and their plan members have access to a number of health and wellness resources designed to provide guidance and support. These resources include a number of webinars which discuss various COVID-19 and mental health-related topics. The webinars are pre-recorded so plan members can stream them at their convenience.
Understanding the Impact of COVID-19 on Your Mental Health
English webinar
French webinar
COVID-19: Loneliness & Isolation Fatigue - Self-Care Strategies
English webinar
French webinar
COVID-19: Dealing with Seasonal Affective Disorder
English webinar
French webinar
Reducing Anxiety & Managing the Transition Back to the Classroom - for Teachers
English webinar
French webinar
COVID-19: Specialized Mental Health Support for Health Care Professionals
English webinar
French webinar
COVID-19: Supporting Children’s Mental Health
English webinar
French webinar
Additional resources, including articles, tools, videos and podcasts, are available at Homeweb.ca/Equitable. Please encourage your clients to share these resources with their plan members.
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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
- 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
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
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
- 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
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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.
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Important notice: Funds with Deferred Sales Charges
The Canadian Council of Insurance Regulators (CCIR) is requiring all insurance companies to discontinue the sale of segregated funds with deferred sales charges (DSC) effective June 1, 2023. This also impacts ongoing or new deposits to some existing segregated fund accounts. Please contact any Equitable Life clients who may be impacted.
How this impacts clients:
In response to the insurance regulator’s recommendation, Equitable Life® will be making changes to the administration of certain segregated fund products, which may impact clients. The details are outlined below:
Pivotal Select™ segregated fund product
On or about May 29, 2023:- Funds with DSC or Low Load (LL) sales charge options will be closed to additional deposits. Future deposits must be allocated to the No Load (NL) sales charge option of the funds available within the policy.
- Any existing amounts held in DSC or LL funds are not impacted and will retain the existing deferred sales charge schedule outlined in a client’s contract. The annual 10% available (20% for RIF policies) for withdrawal without fees continues to apply through to the expiry of the fee schedule.
- If the default deposit instructions that a client previously provided include funds with DSC or LL sales charge options, these instructions will be automatically updated to the NL sales charge option of the same fund for all future deposits.
- If a client has pre-authorized scheduled deposits into funds with the DSC or LL sales charge options, these instructions will be automatically updated to the NL sales charge option of the same funds for all future deposits.
- In alignment with our current administrative rules, if a client has DSC or LL funds, they will not be able to make deposits into No Load Chargeback funds (NLCB and NLCB5) within the same policy.
Legacy segregated fund products
Ongoing deposits to DSC funds are permitted when a segregated fund product does not have an alternative sales charge option available within the contract. This applies to the following products:- Personal Investment Portfolio
- Pivotal Solutions II
- Pivotal Solutions DSC
If a client plans on making additional deposits, they may be interested in alternative sales charge options that do not include DSC. For example, Equitable Life offers “No Load” (NL) and “No Load Chargeback” (NLCB and NLCB5) sales charge options within the Pivotal Select segregated fund contract. In these situations, a new application would need to be completed and submitted.
Please note that draft regulation in Quebec is currently under review which may impact Equitable Life’s approach for Quebec clients with legacy segregated fund products.
Equitable Life will continue to monitor provincial regulatory developments and adjust our approach as needed.
Client communication
We will be sending clients a letter within their December 31, 2022, statement describing their options, and the impacts to their policy (if applicable). We recommend that you contact clients to discuss the contents of Equitable Life’s letter and provide any advice that they may need regarding ongoing deposits to their segregated funds. You can access a copy of the client letter here:If you have any questions, please reach out to our Advisor Services Team at 1.866.884.7427.
December 23, 2022
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