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Equitable Life Group Benefits Bulletin – September 2021
In this issue:
- Right drug, right dose*
- Responding to New Brunswick’s Biosimilar Initiative*
- Helping plan members access our convenient digital options*
- Reminder: Please access forms on EquitableHealth.ca*
- Over-age dependents losing coverage?*
Right drug, right dose
Equitable Life partners with Personalized Prescribing Inc. to help plan members avoid treatment trial and error
Patients suffering from mental health conditions often need to try several medications before they find one that works for them. This is frustrating and can result in negative side-effects, a longer recovery, lost productivity, or a delayed return to work.
To help plan members avoid this treatment trial and error, we have partnered with Personalized Prescribing Inc. to provide easier access to pharmacogenomic testing for plan members with mental health conditions.
Pharmacogenomics 101
Pharmacogenomics is the study of how an individual’s genes influence their response to medications. Pharmacogenomic testing can help determine how compatible a patient’s body may be to a particular drug, and helps their physician prescribe the most appropriate medication. The goal is to ensure the right drug is prescribed to deliver the most positive outcome with the fewest side effects.
Easier access to pharmacogenomic testing
Through our partnership with Personalized Prescribing Inc., any Equitable Life plan member diagnosed with a mental health condition can purchase a pharmacogenomic test for a discounted price of $399 plus HST – a 20% savings.
We are also introducing the option for plan sponsors to add coverage of pharmacogenomic tests provided by Personalized Prescribing Inc. for mental health conditions.
With this coverage, plan members are eligible for pharmacogenomic testing if:- They have been diagnosed with a mental health condition;
- They are currently taking or have stopped taking a medication for a mental health condition that does not work or has side effects; and
- The pharmacogenomic test is conducted by Personalized Prescribing Inc.
Getting a test is easy. The plan member starts by visiting www.personalizedprescribing.com/equitablelife to request a test kit.
Once they receive their test kit from Personalized Prescribing Inc., they simply provide a saliva sample and send it back (postage is pre-paid). Within 7-10 business days, they receive an Rx Report™ that they can share with their doctor. This report includes details to help their doctor prescribe the right drug and the right dose for them.
Benefits for plan members:- The plan member and their physician receive a full report that is easy to understand;
- The report identifies the most compatible medications for the plan member’s condition and the medications to avoid;
- The physician is able to prescribe the most appropriate medication with the fewest side effects; and
- The plan member avoids medication trial and error.
- Pharmacogenomic testing can be an effective prevention strategy to help employees stay healthy and potentially avoid a mental health-related work absence; and
- Employees suffering from mental health conditions may be more productive when they are on the right medication for them.
Responding to New Brunswick’s Biosimilar Initiative
We are changing coverage for some biologic drugs in New Brunswick in response to the province’s Biosimilar Initiative. These changes will help protect your clients from additional drug costs while still providing access to equally safe and effective biosimilars.
What is New Brunswick’s Biosimilar Initiative?
New Brunswick’s Biosimilar Initiative will end provincial coverage of several originator biologic drugs for some or all conditions beginning on December 1, 2021. Patients 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.
What is the impact on private drug plans?
The most significant risk to plan sponsors who maintain coverage of originator biologics is coordination of benefits (CoB) risk. If other insurance carriers follow suit with the province and delist the originator biologics, it could expose a plan that doesn’t delist them to significant coordination of benefits risk.
For example, consider a patient who is covered under two private plans – their employer plan and a spousal plan. If their employer plan was the first payer for the originator biologic but delists the drug, the spousal plan now becomes the first payor. If the spousal plan continues to cover the cost of the originator, it now pays most or all of the cost of the drug.
How is Equitable Life responding?
To protect your clients’ plans from paying additional and avoidable drug costs, we are changing coverage in New Brunswick for most biologic drugs included in the provincial initiative.
Beginning Feb. 1, 2022, plan members in New Brunswick will no longer be eligible for coverage of Humira, Lantus, Humalog and Copaxone 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 those drugs to maintain coverage under their Equitable Life plan.
How will Equitable Life communicate this change to plan members?
We will be communicating with affected claimants in early-December 2021 to allow them ample time to change their prescriptions and avoid any interruptions in their treatment or their coverage.
Can my client maintain coverage of these biologic drugs?
All groups, except myFlex clients, who wish to opt out of this change and maintain coverage of these originator biologics for New Brunswick plan members can submit a policy amendment. Amendments must be submitted no later than Nov. 30, 2021.
Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for New Brunswick plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.
Groups that opt out of this change are also opting out of any future changes to our New Brunswick biosimilar initiative. Their drug plans will continue to cover any additional originator biologics that we subsequently add to the program.
Will this change impact my clients’ rates?
The rate impact of this change and 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.
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 also known as the “originator” biologic. Biosimilars are also biologics. They 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.
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
Helping plan members access our convenient digital options
Some of your clients’ plan members aren’t benefitting from our secure and convenient digital options to access and use their Group Benefits. They can sign up to submit claims electronically for faster claim payments, get claim payments deposited directly to their bank accounts, easily review their coverage details, quickly access their Group Benefits plan booklet, benefits card and more. We’ve made it easier than ever to sign up, with more resources all conveniently located at Equitable.ca/go/digital.
Your clients’ plan members can visit this link to view:- A brochure with all the high-level instructions they need to get started on EquitableHealth.ca and the EZClaim mobile app
- A full video guide on how to access and navigate EquitableHealth.ca
Reminder: Please access forms on EquitableHealth.ca*
We routinely update our Plan Administrator forms on EquitableHealth.ca based on their feedback and to stay compliant with legal and/or regulatory requirements. If your clients need a form, they should always pull the most recent version from EquitableHealth.ca instead of reusing forms they have saved on their computer. Using an old or outdated form may result in processing delays.
Your clients can access the Plan Administrator forms by following these steps:- Login to EquitableHealth.ca
- Select “Documents”
- Toggle between English and French forms
- Click on the document name to download a PDF copy
Over-age dependents losing coverage?*
Some of your clients’ plan members may have dependents who are reaching the maximum age for eligibility under their group benefits plan.
If they are attending school full-time or are disabled, they may be eligible for continued coverage. Plan members with over-age dependents can simply complete the Application for Coverage of Dependent Child Over Age 21 (Form #441) and submit it through our online document submission tool. They can access the tool by logging into their Group Benefits account at www.equitablehealth.ca and clicking My Resources.
If they are not attending school full-time or disabled, they will no longer be covered under the plan. However, they may be eligible for Coverage2go®. It allows individuals who are losing their group coverage to purchase personal month-to-month health and dental coverage that is affordable, reliable and works like their previous group benefits plan. They can choose the level of coverage and protection that suits their personal situation.
There are no medical questions – they simply need to apply within 60 days of losing their health coverage under their group benefits plan.*
Help your clients’ plan members and their dependents who are losing coverage by letting them know about Coverage2go. They can visit our website to learn more about Coverage2go and to get a quote.
*Quebec residents are not eligible for Coverage2go - [pdf] B2B Investment Loan Product Brochure
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Equitable Life Coronavirus Update – March 13, 2020
As the coronavirus (COVID-19) continues to spread, it’s important that you, your clients and their plan members have the most up-to-date information. We are providing timely updates on any developments that impact your clients and their plan members or their benefits coverage.
Please share this information with your clients. You can direct them to EquitableHealth.ca, where we have posted a version of these updates.
Coronavirus travel coverage*
For groups with Travel Assist coverage
The Public Health Agency of Canada has issued several Travel Health Notices advising Canadians to avoid travel to countries and regions where there have been outbreaks of coronavirus (COVID-19).
A good resource to help your clients and their plan members understand how the spread of the coronavirus may impact their travel plans is the Public Health Agency of Canada’s Coronavirus Travel Advice site. The levels of risk by country and region are regularly updated.
If your clients’ plan members cannot avoid travelling, Public Health recommends they take steps to prevent illness and seek medical attention if they become sick.
Where to find the latest information
The list and level of travel advisories can change at any time. Please check the Government of Canada’s Travel Advisor and Advisory page for the most current information.
If your clients’ plan members have coronavirus symptoms while travelling, please advise them to contact Travel Assist at the numbers listed below for assistance.
Advise plan members to call before they travel
If a plan member is travelling anywhere outside of the province or country and their benefits plan includes Travel Assist, plan administrators should advise them to make sure they’re prepared for a medical emergency by following these steps.
- Check the Government of Canada’s Travel Advisor and Advisory page. Note that it is important to click on the country to check whether any specific regions of that country have travel advisories.
- If they have questions, they should call Travel Assist before they travel for assistance and benefit information.
- Pack their Equitable Life benefits card and provincial health card.
- In a medical emergency, call the Travel Assist 24-Hour Hotline:
- Toll-free Canada/USA: 1.800.321/9998
- Global call collect: 519.742.3287
- Allianz Global Assistance ID #9089
Allianz Global Assistance administers Equitable Life’s Travel Assist benefits. Allianz has an international network of medical facilities, transportation providers, medical correspondents and multilingual administrative agents who aid with medical, legal and most travel-related emergencies 24-hours a day, seven days a week.
Early prescription refills and drug shortages*
In response to concerns about COVID-19 TELUS Health, our pharmacy benefits manager, has announced it is maintaining its standard rules for refills of medication. Plan members can refill their medications when at least two-thirds of the last dispensed supply has been used.
If plan members need more than the maximum supply allowed on their plan, they must pay out-of-pocket for the excess amount. They can then submit a claim to ask for an exception request.
TELUS is taking this position to help maintain access to medication for all patients. They continue to monitor the situation. We will provide an update if it changes.
Drug shortages
TELUS Health monitors for drug shortages and updates their system for any unavailable drugs. This helps to ensure accurate claims payment. If a referenced lowest-cost generic drug is unavailable, claims for drugs in the class will be paid at the next lowest-cost generic alternative available.
*Indicates content that will be shared with your clients
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Claims payments and notifications will go fully digital on July 1, 2023
We are committed to providing a better benefits experience. We have secure and convenient digital options to make it easier for plan members to access and use their benefits plan, including EquitableHealth.ca and the EZClaim Mobile app.
Most plan members are already using these tools to set up email claim notifications and direct deposit. They get their claim updates faster and their claims paid more quickly, right into their bank account.
To help ensure that all plan members benefit from faster claim payments and notifications, we are making these services fully digital as of July 1, 2023. That means, in most cases, we will no longer mail paper claim cheques or explanation of benefits (EOB) notifications.**
Plan members who haven’t already activated direct deposit and email notifications will need to activate these services via their plan member account on EquitableHealth.ca.How we’ll help plan members get set up
Fortunately, it’s simple for plan members to set up these features. And it only takes a few minutes. To make it even easier, we’ve created a Plan Member Guide to Getting Started Online. It includes simple instructions to help plan members use our digital features and get the most from their benefits plan.
We have also created a toolkit that plan administrators can email to their plan members to walk them through the simple steps. Access the toolkit here.
And we’re available to guide plan members who may need help. They can call us at 1.800.265.4556 and select “Plan Member Web Support”. Our Client Care Centre Team is happy to help them activate these services.How we’ll communicate with plan members
We will start communicating this change to plan members in April. For plan members who aren’t taking advantage of these convenient features, we will send them an email to let them know about the change, with instructions and support on getting set up.
We will also include an insert with all mailings of paper cheques and EOB notifications sent out. And we will post an announcement and banner on EquitableHealth.ca to let plan members know about the change.
How we’ll support plan members who need extra help or accommodations
After July 1, 2023, we will follow up with plan members who have not yet activated direct deposit or email notifications for their claims and provide any extra help and support they may need. And, of course, we’ll make exceptions for plan members who aren’t willing or reasonably able to use these features.Questions?
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager.
** Disability claimants will continue to receive paper Explanation of Benefits notifications in the mail. Some pay-direct drug claims will also continue to be paid by cheque. - EZcomplete Training and Resources
- [pdf] Daily/Guaranteed Interest Account Advisor Guide
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Insights from a pandemic: COVID-19 and group benefits plans
We’ve received numerous questions about the impact of COVID-19 and what it will mean for benefits plans in the months ahead. Below is a summary of what we’re seeing so far. In the coming weeks, we’ll explore each of these topics in greater depth.
Disability
Initially, as COVID-19 started to spread, we saw STD claims ramp up quickly. Since then, we’ve seen the number of COVID-19-related STD claims slow significantly. As for LTD, we believe both the incidence and duration of those claims will increase in both the short term and medium term due to COVID-19.
Health and Dental Claims
We saw an overall spike in the volume and paid amounts for drug claims in March as plan members rushed to stock up on their medications. This was followed by a drop in April after most provinces put 30-day refill limits in place. One exception was claims for asthma drugs which surged in March but had no drop in April. Overall, the April plunge will be short-lived; drug costs have already begun to rise in May.
While paramedical and dental claims are down, we are seeing an increase in claims for virtual treatments and emergency dental services. We expect that claims will spike once the current pandemic restrictions are lifted. We’ve already started to see claims rise in provinces that are allowing health providers to re-open.
Despite the shift to more virtual services, we haven’t seen an increase in fraudulent activity. But we continue to be vigilant. Our investigative practices – verifying with the plan member that they received the treatment and have a valid receipt, and that the practitioner has treatment notes – remain the same whether treatment is provided in person or virtually.
Technology
During this time of physical distancing, people are looking for ways to interact with their providers virtually. Fortunately, our business model is almost entirely electronic, and we have several convenient digital options available for plan members and plan sponsors. Our focus in recent weeks has been to remind clients and plan members about these tools and make it as easy as possible for them to activate and use them. And we are continually adding functionality that will allow us to serve our customers even better.
Mental Health/Wellness
Usage of i-Volve, Homewood’s online cognitive behavioural therapy tool, increased significantly in March before levelling back down in April and May. And while EFAP cases fell in April and early-May, the number of cases has begun to climb in recent weeks, particularly for anxiety. In the coming weeks and months, we expect an eventual increase in marital and family issues, as well as depression. We’ve also seen an increase in mental-health-related prescriptions.
Plan Design
It’s too early to predict how the COVID-19 pandemic will impact benefits plan design and how it will change in the coming months. We would love to get your feedback and insights about how benefit plans will evolve and what new features or provisions they should include.
Please share your thoughts and suggestions with your Group Account Executive or myFlex Marketing Manager. Or, you can email your ideas to GroupCommunications@equitable.ca.
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Equitable Life Group Benefits Bulletin - July 2021
In this issue:
- Fabien Jeudy takes over as President and CEO*
- Reminder: Equitable Life’s Guide to Accessing Virtual Healthcare*
- Mental health resources for plan members*
- Recall of Philips CPAP machines*
Fabien Jeudy takes over as President and CEO*
In March, we announced that Fabien Jeudy was appointed as Equitable Life’s next President and CEO. Jeudy officially took over on July 5th, succeeding Ronald Beettam, who is retiring after 16 years with the company.
Jeudy is a collaborative leader with more than 30 years of experience in the insurance industry, leading actuarial, finance, risk management, distribution, marketing teams and operational teams in the Life & Health Insurance, Wealth Management and Group Benefits markets in Canada, the US, and Asia.
Reminder: Equitable Life’s Guide to Accessing Virtual Healthcare*
The demand for virtual healthcare services has increased as the pandemic is driving more people to access their health care providers from home.
Thankfully, many virtual healthcare services are available for free to Canadians with provincial health care coverage. We have created a Guide to Accessing Virtual Healthcare for plan members to easily access a variety of virtual healthcare services. Our guide includes information and links to both free and paid virtual medical care options, including video appointments, health advice over the phone, emergency dental services, and more.
You can find the guide on our website. It’s also available on our plan member website at EquitableHealth.ca.Mental health resources for plan members*
Many Canadians have been experiencing increased levels of stress, anxiety, and depression since the beginning of the COVID-19 pandemic. 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.
Homewood’s Online Cognitive Behavioural Therapy tool, i-Volve, can help plan members identify, challenge and overcome anxious thoughts, behaviours and emotions. Learn more about Online CBT or access i-Volve at Homeweb.ca/Equitable.
As well, Homewood has a number of resources available to help support plan members dealing with increased anxiety during these uncertain times:- Quelling COVID-19 Anxiety
- Managing stress and anxiety
- How to speak to children
- How to stay productive and motivated when working from home
- The COVID-19 Pandemic: Managing the Impact
- Support for First Responders, Front Line Workers and Public Facing Employees
- Financial tips for your financial health
- Increases in Domestic Violence
- Those with family members in long-term care facilities
- COVID-19: Employee Fatigue, Isolation and Loneliness
Recall of Philips CPAP machines*
Last month, electronics company, Philips, issued a recall with Health Canada of some of its Continuous Positive Airway Pressure (CPAP), BiLevel Positive Airway Pressure (BiLevel PAP) devices and Mechanical Ventilators. The recall was issued due to a foam abatement within the machines that can become loose and cause potential health risks.
To qualify for repair or replacement of these devices, users must register their machine on the Philips website.
CPAP, BiLevel PAP devices and Mechanical Ventilators are eligible for coverage under an HCSA and under some Extended Health Care plans. Plan administrators may want to inform plan members of this recall if the devices are eligible for coverage under their plan.
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Make Equitable your first choice for insurance – has just been enhanced!
Our popular marketing piece – Make Equitable® your first choice for insurance (1510) – just got an update with the latest life insurance offerings and our new branding.
It is a great conversation starter that can help…
● Encourage clients to discover the benefits of our insurance solutions.
● Start the life insurance needs conversation.
● Help clients understand the Equitable ‘difference’ – that our full focus is on the interests and well-being of our policyholders.
Learn more by visiting our marketing materials page.
Questions?
Please contact your local wholesaler.
® or ™ denotes a trademark of The Equitable Life Insurance Company of Canada.
- [pdf] EquiLiving Product Summary (Adults)