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Group Benefits - Premium relief for Dental and Extended Health Care benefits
We know this is a difficult time for Canadian employers and that many of your clients are facing financial hardship as a result of the COVID-19 pandemic. We continue to look for ways to help employers manage while still supporting their employees.
With many health practitioners closing their offices due to the pandemic restrictions, plan member use of dental benefits and some health benefits has declined.
So, we are pleased to announce that we are offering premium relief for all Traditional and myFlex insured non-refund customers for Health and Dental benefits, as follows:
- A 50% reduction on Dental premiums; and
- A 20% reduction on vision and extended healthcare rates (excluding prescription drugs), which equates to an 8% reduction on Health premiums.
These reductions are retroactive to April 1, 2020 and will appear as a credit against the next available billing. We will assess the situation monthly and expect to continue with monthly refunds for as long as the current crisis period continues.
We expect that claims experience and premiums will return to normal once the current pandemic restrictions are lifted.
In the meantime, plan members will continue to have full access to their benefits coverage throughout the pandemic. In many cases, dental offices remain open for emergency services, and a variety of healthcare providers are available virtually.
Commissions
We know the pandemic has put financial strain on your business as well, so we will continue to pay full compensation. Although your overall commission will be unaffected by these premium reduction adjustments, you may see a temporary reduction in your commission payments if you are on a pay-as-earned basis while we put through mass changes. If so, we will then make an additional top-up payment to cover that shortfall as soon as we are able.
Communication
We will be communicating this premium relief program to your clients April 21st at 8:00am EST.
A PDF of the communication is also available here.Questions?
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager. In the meantime, we have provided some Questions and Answers below.
Will the premium reduction on Health and Dental benefits have an impact on the renewals that were deferred?
No. Renewals will proceed as normal, with rate adjustments based only on months where full premium was paid. For most clients, we anticipate “normal” rate adjustments at renewal compared to rates paid prior to refunds taking effect.
Does this adjustment apply equally to clients who have had their renewal deferred?
Yes, these adjustments apply to all Traditional and myFlex insured, non-refund customers for Health and Dental benefits.
How does this affect clients who have terminated or amended a plan?
If a benefit is in-force during the month of April, the adjustment will be credited to the next available billing. For clients who have temporarily terminated all benefits, this will be applied against the first bill once benefits have been reinstated. No cash refunds will be paid.
Will you recover any of the adjustment at a future point in time?
No, we will not recover this adjustment.
Instead of this premium reduction adjustment, can a client cancel or adjust some of the benefits on their plan?
Yes, you and your clients always have the option of changing the coverage on a plan, such as reducing or removing a benefit to help control costs. Please speak to your Group Account Executive or myFlex Sales Manager about the options available.
Are TPAs and self-administered groups eligible for the premium reduction?
Yes. TPAs and self-administered groups are eligible for the premium reduction. However, timing for the credit will be dependent on the billing practices of the TPA or self-administered group. We will apply these credits as soon as we are able. -
February 2023 eNews
Responding to Nova Scotia’s biosimilar switch initiative
We are changing coverage for some biologic drugs in Nova Scotia in response to the province’s biosimilar initiative. These changes will help protect your clients’ plans from additional drug costs that may result from this new government policy while providing access to equally safe and effective lower-cost biosimilars.Nova Scotia’s provincial biosimilar initiative
Announced in February 2022, the Nova Scotia Biosimilar Initiative ends coverage of seven biologic drugs for residents enrolled in Pharmacare programs.
Pharmacare patients in the province using these drugs will be required to switch to biosimilar versions of these drugs by February 3, 2023, in order to maintain their Nova Scotia Pharmacare coverage.Equitable Life’s response
To ensure this provincial change doesn’t result in your clients’ plans paying additional and avoidable drug costs, we are changing coverage in Nova Scotia for most biologic drugs included in the provincial initiative.
Beginning June 1, 2023, plan members in the province will no longer be eligible for most originator biologic drugs if they have a condition for which Health Canada has approved a lower cost biosimilar version of the drug.** These plan members will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable Life plan.Can my client maintain coverage of these biologic drugs?
Traditional groups who wish to opt out of this change and maintain coverage of these originator biologics for Nova Scotia plan members can submit a policy amendment. Amendments must be submitted no later than April 1, 2023. Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for Nova Scotia plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.
Groups that choose to maintain coverage of these originator biologics for existing claimants will also maintain coverage for any originator biologics that we subsequently add to our Nova Scotia biosimilar initiative.Will this change impact my clients’ rates?
The rate impact of this change in coverage will be relatively insignificant. 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.Communicating this change to plan members
We will inform any affected plan members in April of the need to switch their medications so that they have ample time to change their prescriptions and avoid any interruptions in treatment or coverage.What is the difference between biologics and biosimilars?
Biologics are drugs that are engineered using living organisms like yeast and bacteria. The first version of a biologic developed is known as the “originator” biologic. Biosimilars are highly similar to the drugs they are based on and Health Canada considers them to be equally safe and effective for approved conditions.Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
**The list of affected drugs is dynamic and will change as Nova Scotia includes more biologic drugs in its biosimilar initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.
Changes to New Brunswick drug interchangeability rules
We are introducing changes to help ensure that your clients with voluntary or mandatory generic pricing for their drug plans will benefit more from the cost savings of these two features, regardless of the province where the drugs are dispensed.
Currently, when determining whether a lower-cost alternative is available for a brand-name drug, most insurers only consider drugs that the provincial drug plan identifies as interchangeable.
However, the public drug plan in New Brunswick does not identify a drug as interchangeable if the drug is not listed on its formulary – even if Health Canada has deemed the drug interchangeable.
As a result, plans with mandatory or voluntary generic pricing have continued to reimburse some drugs in New Brunswick based on the cost of the brand-name drug, even if a lower-cost generic alternative is available.
Effective March 20, 2023, if your clients have drug plans with mandatory or voluntary generic pricing, we will adjudicate any drug claims in New Brunswick using the lowest cost alternative that Health Canada approves as bioequivalent. This will occur even if the public drug plan has not identified the drug as interchangeable.
To benefit from this more robust drug plan control, plan sponsors must have mandatory or voluntary generic pricing in place.
For more information about this change or about implementing mandatory or voluntary generic pricing for your clients, please contact your Group Account Executive or myFlex Sales Manager.
New template: plan members eligible for additional coverage
Often, based on salary, some plan members may become eligible to apply for extra Life, Accidental Death & Dismemberment (AD&D), Short Term Disability or Long Term Disability coverage. If this occurs, your clients receive a notification from Group Benefits Administration. We have now developed a template that your clients can provide to applicable plan members if they become eligible for extra coverage. The template makes it simpler for your clients to pass on these details to their plan members efficiently.
The new template is available for download under the Quick Links section of EquitableHealth.ca. It is a fillable PDF form that your clients can complete and provide to their plan members when necessary. The document is called Over the Non-Evidence Limit for Plan Members Notification.
If you have any questions about the template, please contact your Group Account Executive or myFlex Sales Manager. - [pdf] TFSA Third Party Contribution
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March 2026 eNews
In this issue:
Equitable is adding nutrition app to all group benefits plans*
Coming soon: One-time passcodes will be added to account login process*
Standardized CLHIA disability form is now part of our disability claims submission package*
Reminder: Review manual allocations for HCSAs and/or TSAs*
Protecting clients’ plans from benefits fraud*
*Indicates content that will be shared with your clients.
Equitable is adding nutrition app to all group benefits plans
Equitable is making healthy eating easier and more accessible for all group benefits plan members. Beginning in April, access to the RxFood mobile app will be added to every Equitable group benefits plan—at no extra cost.
This will put personalized nutrition insights, practical tips and tailored recommendations at every plan member’s fingertips—helping them make more informed food choices that can either help prevent or manage chronic conditions, such as diabetes, high cholesterol and heart disease.
What is RxFood?
RxFood is Canada’s first clinically validated nutrition platform that’s used and trusted by leading health care institutions across the country, including SickKids Hospital, Diabetes Canada, Children’s Hospital of Eastern Ontario (CHEO) and more, to support better health outcomes through nutrition.
While we can track many aspects of our daily health—steps, heart rate, sleep, and blood sugar—food is often overlooked. RxFood helps close that gap by using technology that’s powered by artificial intelligence (AI) to turn everyday meals into meaningful health insights.
How it works
A plan member takes photos of their meals with their smartphone. RxFood will analyze what's on their plate, from nutritional quality to portion sizes, then provide personalized feedback, easy-to-follow suggestions and recipes with ingredient options tailored to their budget.
After a few days of logging, they’ll receive a comprehensive nutrition summary showing how their eating patterns align with their personal health goals, and where to go from there.
Check out the following video to learn more about RxFood— and how Equitable is putting the power to eat healthy in the hands of plan members.
Coming soon: One-time passcodes will be added to account login process
This spring, Equitable will launch a new multi-factor authentication (MFA) security measure to further enhance our digital security. When our new feature takes effect, anyone logging in to EquitableHealth.ca® and the Equitable EZClaim® mobile app with an email address and password may be required to enter a one-time passcode they receive via email. This will further safeguard their account access and personal data.
Keep it simple – create a passkey
If you don’t want to enter a one-time passcode when logging into your account, you can skip this extra step all together by creating a passkey on your mobile device or computer.
Passkeys are safe and provide a quicker, easier way to log in while also enhancing account security. They use either biometrics–your face or fingerprint–or a PIN authenticator to confirm your identity.
If you create and use a passkey to log in, you won’t need to enter a one-time passcode.
Learn more about passkeys. The set-up process is simple. The two videos below guide you through creating a passkey on both your mobile device and computer.
Client and plan member communications
We will share this information with clients and group benefits plan members before we introduce our new security measure. Please reach out to your Group Account Executive if you have any questions.
If you use the same email address to log in to your accounts on EquitableHealth.ca, EquiNet® and Equitable Client Access®, you can use the same passkey. Equitable Client Access is our secure site for Individual Insurance and Individual Wealth clients.
Standardized CLHIA disability form is now part of our disability claims submission packageClients with employees who are submitting short-term or long-term disability claims should be aware that we’ve changed one of the required forms in our disability claim submission package.
The Canadian Life and Health Insurance Association’s (CLHIA) Initial Disability Insurance Medical Statement has replaced our Attending Physician’s Statement (APS) form.
Our disability claim application packages on Equitable.ca and EquitableHealth.ca now include the CLHIA standardized form instead of our APS form. Our old form is no longer available on our websites.
We will continue accepting our previous APS form for initiating disability claims for now. However, we’re encouraging clients to begin using the standardized form as soon as possible. Using a standardized form for disability claims across the group insurance industry helps reduce the administrative burden on physicians by simplifying the disability application process.
If you have any questions, please contact your Group Account Executive.
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.
Plan administrators can update these amounts on EquitableHealth.ca. Here are the steps:- 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 12/31/2026
- Select Next
- Select Finish
- View Report
Protecting clients’ plans from benefits fraud
March is Fraud Prevention month – the perfect time for clients to educate their plan members on the consequences of benefits fraud.
According to the Canadian Life and Health Insurance Association (CLHIA), benefits fraud costs millions each year and can contribute to higher premiums for plan sponsors.
These resources can help clients and plan members prevent benefits fraud:- CLHIA’s free 15-minute Protect Your Benefits online course for plan administrators and their members
- CLHIA’s Fraud is Fraud program, including their FAQs on benefits fraud
- CLHIA's 10 tips to 'Protect your benefits' for plan members
How we protect against benefits fraud
Our Investigative Claims Unit (ICU) uses a range of techniques, including CLHIA‑led tools, to detect and prevent benefits fraud:- Joint Provider Fraud Investigation Program: Allows insurers to collaborate on fraud investigations that affect multiple insurers.
- Data Pooling Program: Pools data between insurers and uses advanced artificial intelligence (AI) to further identify and reduce benefits fraud.
- Provider Alert Registry: Allows insurers to view the results of other insurers’ anti-fraud investigations into specific practitioners.
To learn more, contact your Group Account Executive. - [pdf] Equitable Guaranteed Investment Funds – Investment Class
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