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  1. Equitable Life Group Benefits Bulletin - November 2022

    The importance of timely plan member eligibility updates*

    Effective Dec. 1, 2022, we are implementing a revised process for managing plan member and dependent health and dental claims that have been incurred and paid after coverage has been terminated. This new process is consistent with industry practices.
     
    If health or dental claims have been incurred and paid after a plan member’s termination date but before we received notice of the termination, we will align the plan member’s or dependent’s termination date with the service date of the last paid claim, retaining premiums up until that date.
     
    If no claims have been incurred and paid after the termination date, Equitable Life will process the termination as requested and refund any excess premium, subject to a maximum premium refund credit of three months.
     
    Currently, we process the termination as requested and attempt to recover any claim overpayments directly from the plan member. We then refund any excess premiums that have been paid, subject to the maximum refund credit amount.
     
    To avoid claims being incurred and paid after a plan member’s termination date, it is important for your clients to update plan member and dependent eligibility dates on or before the effective date of the change.
     
    If you have any questions about the process your clients should follow for updating plan member eligibility, please contact your Group Account Executive or myFlex Sales Manager.

    QuickAssess®: Absence and accommodation request review services*

    It can be difficult to navigate chronic or complex cases of absenteeism or accommodation requests. That’s where QuickAssess® can help.
     
    QuickAssess is an optional, fee-per-use service that can provide your clients with an unbiased, timely assessment of complex plan member absences and workplace accommodation requests. Our disability experts can provide recommendations to help your clients manage:
    • Workplace absences
    • Chronic or patterned absenteeism
    • Requests to modify workplaces or duties
    • Return-to-work coordination
    • Employee Insurance sick leaves
    Based on a thorough review of information provided by the plan sponsor, the plan member, and their physician, our QuickAssess specialists provide a recommendation within two business days on how to manage the absence or accommodation request.** Your clients can then decide how to manage the plan member request and communicate their decision accordingly.
     
    For more information on using QuickAssess, including eligibility requirements, please contact your Group Account Executive or myFlex Sales Manager.

    **Within two business days of receiving a completed QuickAssess Absence and Accommodation Review Referral Form and all required information. For more complex referrals, more time will be required.

    Finding a health care provider with TELUS eClaims direct billing*

    By visiting TELUS’s Find a Provider page, your clients’ plan members can now easily search for paramedical and vision providers who are registered on the TELUS Health eClaims network and who can submit claims directly to us on behalf of their patients. Searches can be filtered by postal code to help plan members find the most convenient provider options.

    As our direct billing provider for pharmacy, vision and paramedical claims, TELUS Health has an extensive network of 70,000 health care providers that provide direct billing to streamline the claims process.

    Please note, plan members should always check Equitable Life’s list of de-listed providers before selecting a health care provider. The list is available for your clients and their plan members on EquitableHealth.ca, and is updated regularly.

    For more information about TELUS eClaims, please contact your Group Account Executive or myFlex Sales Manager.

    First phase of the Canada Dental Benefit proposed for Dec. 1, 2022*

    The federal government’s new Canada Dental Benefit is proposed to take effect on Dec. 1, 2022, subject to Parliamentary approval. The program will cover eligible expenses retroactive to Oct. 1, 2022, and this first phase would apply to Canadians under 12 years of age.

    If implemented, the Canada Dental Benefit will provide dental care to Canadian families with under $90,000 adjusted net income annually. By 2025, the federal government expects to extend the benefit to children under 18, senior citizens and Canadians with disabilities.

    Parents or guardians will be required to apply for this coverage through the Canada Revenue Agency (CRA) and must not have private dental coverage for the child(ren).

    This new program will have no impact on your clients’ dental coverage and no action is required on their part.

    * Indicates content that will be shared with your clients.
     
  2. [pdf] DSC/Transfer Fee Recovery Program – FAQ
  3. Equitable Life Group Benefits Bulletin – March 2022 In this issue: *Indicates content that will be shared with your clients
     

    CLHIA launches industry anti-fraud initiative*

    In February, the Canadian Life and Health Insurance Association (CLHIA) announced a new anti-fraud initiative that is using advanced artificial intelligence (AI) to further identify and reduce benefits fraud.
     
    Equitable Life is excited to be a part of this important initiative. It will enhance our own fraud detection analytics by using AI to connect the dots across a huge pool of anonymized claims data. This will lead to more investigations and actions to mitigate the impact of fraud on your clients’ plans.
     
    The initiative is being led by the CLHIA and member insurers and is supported by technology provider Shift Technologies. It will be further rolled-out and expanded over the next three years.
     
    Benefits fraud affects more than just insurers. The costs of fraud are felt by employers and their employees as well. We are looking forward to being able to better identify and reduce benefits fraud.
     

    Provincial biosimilar update*

    BC expands its biosimilar initiative
    BC Pharmacare recently announced it is adding two rapid-acting insulins to the list of drugs included in its ongoing initiative to switch patients to biosimilar versions of high-cost biologics. Patients taking Humalog or NovoRapid for Type 1 or Type 2 diabetes will be required to switch to a biosimilar version of the drugs by May 29, 2022 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 Humalog or NovoRapid for plan members in BC. Effective June 1, 2022, claimants currently taking Humalog or NovoRapid will be required to switch to a biosimilar version of the drugs to maintain coverage under their Equitable Life plan and their BC Pharmacare plan.

    We will be communicating this change to plan administrators later this week. And we will be communicating with affected claimants in early April 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.

    Nova Scotia and Northwest Territories introduce biosimilar initiatives
    The governments of Nova Scotia and the Northwest Territories each recently announced they are launching biosimilar initiatives to switch patients from certain originator biologic drugs to biosimilar versions of the drugs.

    Patients in Nova Scotia using affected originator biologic drugs will have until February 2023 to switch to a biosimilar version of their medications in order to maintain coverage under the province’s public drug plans. Patients in the Northwest Territories will have until June 20, 2022, to switch.

    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.
     

    Quebec decreasing insurance premium tax*

    The Quebec Government has announced that it plans to decrease its Insurance Premium Tax rates effective April 1, 2022. The premium tax rates for group life and accident and sickness insurance are expected to decrease from 3.48% to 3.3%. The new tax rates will be applied to premiums for the billing period beginning on or after April 1, 2022.
     

    Coming soon: A survey to understand how we can better serve your clients’ needs*

    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.
     
    In the coming weeks, we will conduct a survey of your clients to help us understand how we can better serve them. On March 28, we will send plan administrators an email with a link to the survey. The survey will remain open until the end of the day on April 11 and 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 may also follow up with plan administrators directly 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 25 prepaid gift cards for $25.
     

    Remind your clients’ plan members in BC, Manitoba and Saskatchewan to register for Pharmacare*

    If your clients have plan members in British Columbia, Manitoba or Saskatchewan, the provincial government offers a Pharmacare program to support prescription drug costs.  Plan members in these provinces must register for their provincial Pharmacare program to maintain coverage under their Equitable Life drug plan.
     
    Registration is easy! We will send two registration reminder messages directly to plan members’ pharmacists and post them on their Explanation of Benefits. We’ve also created a step-by-step guide that your clients can share with their plan members.
     
    English version
    French version
     
    For more information about the provincial Pharmacare programs, including how plan members can register, please visit:
     
    For British Columbia residents: https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents  
     
    For Manitoba residents: https://www.gov.mb.ca/health/pharmacare/apply.html
     
    For Saskatchewan residents: https://www.saskatchewan.ca/residents/health/prescription-drug-plans-and-health-coverage/extended-benefits-and%20drug-plan/drug-cost-assistance#eligibility
     
     
  4. Insights from a pandemic: Long-term COVID-19 drug risks

    For the remainder of 2020 and beyond, COVID-19 will continue to add to the existing pressures driving up drug costs. Examples of contributing factors include:

    • Claims for acute drugs will likely increase as elective surgeries resume and plan members address non-emergency health issues that were left unattended during COVID-19.
    • Plan members whose employers are facing financial strain due to COVID-19 may stock up on their prescriptions in anticipation of losing their job and/or their benefits.
    • An ongoing increase in the prevalence and severity of mental health issues and chronic conditions. In May and June, we saw a dramatic increase in the number of claimants for depression, ulcers, blood pressure and diabetes, and depression was associated with 1 in 5 claimants.

    All trends thus far suggest we can expect about a 10% increase in average paid amounts per certificate in 2020 compared with 2019. But the impact won’t be the same for all groups. There will be significant variations, particularly for smaller groups, and some may see much larger cost increases.

    Unknown COVID-19-related risks

    Another risk exposure may come from the costs associated with drugs used to treat or prevent COVID-19. There are currently numerous vaccines in development, and more than 300 clinical trials are underway for both new and existing drugs to determine their effectiveness in treating the virus.

    The cost of any vaccine or whether government or private plans will pay for it is unknown. Regardless, there will likely be other drugs indicated for the treatment or prevention of COVID-19 that private plans will be expected to cover. The cost of this impact for private payers is unknown, but potentially high.

    Another unknown is what will happen with dispensing fees. While most provinces have lifted their 30-day prescription refill limits, it remains to be seen whether pharmacies will resume dispensing 60- and 90-day refills at pre-COVID levels for private plans. If not, this would mean the dispensing fees will continue to drive up drug costs.

    COVID-19-Drug-Claims-Graphs-Part-2.png

    Advisor opportunity

    Despite the increase in drug plan risk in recent years, little has changed in plan design trends. Very few plan sponsors have adopted managed plans or other plan design options that could help manage risk.

    This presents an opportunity for advisors to educate their clients about the risks their drug plan may be exposed to and the options available to manage that risk.

    A practical starting point for those conversations is our Drug Plan Design Tool. With two simple questions, it can help confirm your client’s objectives and identify some best-fit solutions for their plan.  Ask your Group Account Executive or myFlex Sales Manager for a copy of the tool.

  5. Equitable Life Group Benefits Bulletin - Group Advisor Bonus Enhancement Announcing our Enhanced Group Advisor Bonus Program
     
    We have enhanced our Group Advisor Bonus program to make it more competitive and to help support you in building your business with Equitable Life in 2022. We have updated the structure of the bonus program to make it easier for you to qualify, as well as increased the amounts we pay.
     
    Beginning for sales effective in 2022 we have:
    • Decreased the minimum premium required to qualify for the Sales Bonus to $35,000 from $150,000.
    • Moved away from using Graded Annualized Premium for both the Sales and Persistency Bonus and are using actual Annualized Premium instead, up to a maximum of $500,000 per policy. This simplifies the program and aligns us with the rest of the industry.
    • Increased the Sales Bonus payout to up to 5% of Annualized Premium for Traditional Sales and up to 3% of Annualized Premium for myFlex sales. 
    • Changed the minimum annual premium threshold for the Persistency bonus to $500,000 of capped Annualized Premium from $500,000 of Graded Annualized Premium to make it easier for you to qualify.
    Premiums associated with benefits on retention accounting or Administrative Services Only (ASO), Equitable HealthConnector® services, Group Critical Illness and Health Care Spending Accounts will no longer be counted towards the Sales Bonus.
     
    These enhancements do not apply to advisors who are not part of our standard Advisor Bonus program and who have special bonus arrangements in place. If you have a special bonus arrangement in place and would like to switch to the standard program, please contact your Group Account Executive or myFlex Sales Manager.
     
    Below is a table comparing the current Sales Bonus structure and payout. For full details, please refer to the Group Advisor Compensation and Recognition brochure.
     
    Enhanced Sales Bonus
    For the new Sales Bonus, the Payout Band is based on total combined Traditional and myFlex Benefits new annualized premium (capped at $500,000 per policy). The Sales Bonus Rates for both Traditional sales and myFlex sales are shown in the table below:
     
    New Sales Bonus Rates
    Payout Band Capped Annualized Premium* Sales Bonus Rate
    (from first dollar)
    Traditional Sales myFlex Sales
    1 $34,999 and under 0% 0%
    2 $35,000 to $99,999 3.5% 1.5%
    3 $100,000 and over 5% 3%
    *Total Traditional and myFlex new business sales combined, capped at $500,000 per policy.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    If you have any questions about the Advisor Bonus enhancements, please contact your Group Account Executive or myFlex Sales Manager.
     
  6. 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.
     
  7. Dividend Withdrawals and Change and Premium Offset
  8. What’s your saving style? 

    A TFSA for its flexibility or an RRSP for tax-deferred growth.   

    Did you know? More than 65% of people who put money into a TFSA* earn less than $80,000 a year. That’s why TFSAs are popular with middle-income Canadians. They’re simple and flexible: you don’t get a tax break when you put money in, but you don’t pay tax when you take money out. This makes them great for people who don’t get big benefits from tax deductions.  

    On the other hand, 54% of RRSP contributors earn more than $80,000 per year*. RRSPs often work better for higher-income earners because contributions lower taxable income. That means bigger tax savings for people in higher tax brackets.  

    Here’s the good news: From January 1 to March 2, 2026, when clients open or add money to an Equitable TFSA or RRSP, they’ll be entered into Equitable’s Snowball Your Savings contest. Two winners will be chosen—and their advisors will celebrate too!  


    How to Enter  

    Advisors can help clients submit contributions through EZcomplete® or process transactions using EZtransact®. Every entry is a chance to win!  

    Want ideas to boost contributions and help Canadians save more? Connect with your Director, Investment Sales today.  


    * Source: advisor.ca/news/tfsas-more-popular-than-rrsps-in-2023/  
    ® and ™ denote trademarks of The Equitable Life Insurance Company of Canada.   
    Equitable’s Snowball Your Savings contest: No purchase necessary. Contest period January 1, 2026 to March 2, 2026.  Enter by making a deposit to an Equitable Tax-Free Savings Account or Registered Retirement Savings Plan during the contest period or by submitting a no-purchase entry. Two prizes of $5,000 CAD to be drawn on March 23, 2026 will be awarded. The servicing advisor for the contract to which the selected entrants made the deposit is also an eligible winner and will receive a $1,000 CAD prize. For example, if an Equitable client is a winner of the $5,000 prize, the client’s servicing advisor for the relevant contract wins a $1,000 prize.  Open to legal residents of Canada of the age of majority. Odds of winning depend on number of eligible entries received during the Contest Period.  For full contest rules, including no-purchase method of entry, see the full contest rules.  
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