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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.
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Equitable Life Group Benefits Bulletin – May 2020
In this issue:
- Digital options for your clients and their plan members*
- Alberta delaying biosimilar initiative*
- Yukon increasing insurance premium tax*
- Manitoba and New Brunswick relaxing drug limits*
- Free guide to accessing virtual healthcare*
- Homeweb for plan members who are losing coverage*
*Indicates content that will be shared with your clients
Easy and convenient digital resources for your clients and their plan membersDuring this time of physical distancing, people are looking for ways to interact with their providers virtually. We have several convenient digital tools available to make it easier for your clients and their plan members.
For plan administrators:
Plan administrator portal (EquitableHealth.ca)Our secure portal allows plan administrators to easily manage their plan anytime and anywhere. Instead of printing and mailing forms, they can make real-time updates at their convenience. The site also makes it easy to:
- View or upload forms and other important documents;
- Retrieve billing information;
- Estimate monthly premium costs; and
- View announcements, tips and reminders.
Plan administrators can visit www.equitablehealth.ca to activate their account.
Digital Welcome Kits
Instead of paper kits that can easily get lost or quickly become outdated, plan members receive personalized welcome kits via an interactive email, including instructions on how to:
- Activate their online group benefits account;
- Download their digital benefits card;
- Submit claims from their computer or mobile device;
- Review their coverage details; and
- Explore health and wellness resources.
Easy automated payments
Automated payments are a convenient way to avoid missed payments, suspended claims and disruption. Plan administrators simply complete the pre-authorized debit form and send to GroupCollections@equitable.ca. Or contact Group Collections about online banking and electronic funds transfer (EFT).
We can help
For assistance, plan administrators can contact their Client Relationship Specialist or our Web Services team at 1.800.265.4556 ext. 283 or groupbenefitsadmin@equitable.ca.
For plan members:
Plan member portal (EquitableHealth.ca)By logging into EquitableHealth.ca, plan members have secure 24/7 access to their personalized Group Benefits account. They can:
- View and submit claims;
- Review their coverage details; and
- Access health and wellness resources.
Electronic claims payment and notifications
Once plan members have activated their Group Benefits account on EquitableHealth.ca, they can easily set up receiving their claim payments via direct deposit, and their claim notifications via email.
EZClaim Mobile App
Submitting claims is fast, easy and secure with the Equitable EZClaim® mobile app for iOS and Android devices. Plan members can view and submit health and dental claims and review their coverage details.
Digital Benefits Cards
Instead of digging through their wallets, plan members can download a digital version of their benefits card to their mobile device.
We can help
We’ve created a video guide to help plan members access and use their digital resources. For further assistance, plan members can contact our Web Services team at 1.800.265.4556 ext. 283 or groupbenefitsadmin@equitable.ca.
Alberta government delaying biosimilar initiativeAs we announced in the February 2020 issue of eNews, the Alberta Biosimilar Initiative will require patients using several originator biologic drugs to switch to a biosimilar in order to maintain coverage through their Alberta government sponsored drug plan.
Due to the increased demands the COVID-19 pandemic is placing on healthcare providers, the Alberta government has postponed the switching requirement. Affected patients will now have until January 15, 2021 to switch to the biosimilar version of their drug in order to maintain provincial coverage.
We continue to investigate appropriate options to help ensure this provincial change does not unreasonably impact Equitable Life groups and patients and will keep you informed.
For more information about the Alberta Biosimilars Initiative, consult the Alberta government website.
Yukon increasing Insurance Premium TaxThe Yukon Government has announced that it plans to increase its Insurance Premium Tax rates effective January 1, 2021. The premium tax rates for group life and accident and sickness insurance are expected to increase from 2% to 4%. The new tax rates will be applied to premiums paid on or after January 1, 2021.
Manitoba and New Brunswick relaxing drug limitsIn order to protect the drug supply during the COVID-19 crisis, residents of most provinces were temporarily limited to receiving a 30-day supply of drugs when filling a prescription. Normally, doctors prescribe a 90-day supply for most maintenance-type drugs.
The Government of Manitoba and the Government of New Brunswick are now relaxing this 30-day limit for prescription drugs where shortages do not exist. They will address potential shortages of specific drugs if necessary.
As the situation continues to evolve, there may continue to be changes to provincial legislation and prescription limits. Plan members should speak to their pharmacist for the most up to date information.
Free guide to accessing virtual healthcareWith many health clinics closed and the healthcare system under strain, people are looking to access a doctor and other health providers virtually.
As we announced previously, we’ve made it easier for plan members to find the information they need using our Guide to Accessing Virtual Healthcare. This online resource provides information about and links to a range of virtual health services they need to take care of their health and the health of their family during these challenging times.
The Guide also indicates which services are covered by public health plan, so there’s no cost to the patient to access them if they provide their valid provincial health card.
We will continue to update the Guide as more virtual healthcare providers and services become available.The Guide is available on both EquitableHealth.ca and Equitable.ca.
Homeweb for plan members who are losing coverageWe know these are difficult times for Canadian employers and their employees. As businesses temporarily suspend operations, some employers have had to make the difficult decision to temporarily lay off employees or put their benefits coverage on hold.
That’s why we were pleased to announce that Homewood Health® and Equitable Life will extend access to Homeweb, a personalized online mental health and wellness portal, for up to 120 days for plan members who have temporarily lost their benefits coverage due to COVID-19.
Employees and their family members will continue to have access to the Homeweb website and mobile app, including:
- iVolve, online self-directed Cognitive Behavioural Therapy;
- Resources to support themselves and their family members through the COVID-19 pandemic;
- An interactive online Health Risk Assessment; and
- An online library of tools, assessments and e-courses.
This will allow businesses undergoing financial hardship to provide some support to employees who are temporarily without benefits coverage.
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