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  1. 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.
  2. Resources
  3. [pdf] Investment Direction Form - DIA/GIA
  4. eDelivery of a Contract - New Business
  5. 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 only

    Group 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:

    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.

  6. [pdf] Additional/Updated Client Information
  7. Paramedicals are Re-opening Shortly We are pleased to announce that face-to-face insurance testing paramedical services, including the collection of vitals & fluids, are resuming shortly.  Our service providers, Dynacare and ExamOne, have been monitoring the public health standards and have established standards they will operate under to protect the health of both the applicant and health professionals.
     
    Our commitment to your client’s safety
    It is Equitable Life's commitment that both clients and advisors will be provided clear and thoughtful communication before initiating any testing. Clients should fully understand the potential risks associated with having a paramedical test taken at this time and are always able to choose not to attend the appointment if they do not feel comfortable or safe.
     
    How will paramedical services be conducted?
    Dynacare is conducting appointments at fixed site facilities where clients will travel to the health professional for their appointment. The paramedical questions will be covered by video or telephone to minimize the time spent in the fixed site facility. For more information, see Dynacare’s COVID-19 client guide that will be provided to the client directly.
     
    ExamOne examiners will travel to the client’s home for their appointment and the entire paramedical will be conducted at that time. Information about ExamOne’s COVID-19 processes and their Preparing for my exam client guide will also be provided to the client directy.
     
    When are paramedical services re-opening?
    In person paramedical services for Equitable Life cases will begin opening gradually. We have worked closely with our service providers, the CLHIA & provincial governments and believe it is prudent to begin re-opening services in the provinces that have a lower incidence of COVID-19.  We will expand the schedule as the incidence of COVID-19 lowers or is expected to lower in specific regions.
     
    Please note if you had an order in process prior to services shutting down, the provider will be looking to re-open and complete those orders. If requirements are no longer needed given the non-med limit changes, the order will remain closed.
     
    Schedule for re-opening paramedical services:
    Province Start Date
    Saskatchewan June 1-Dynacare, June 11-ExamOne
    New Brunswick June 8-Dynacare, June 11-ExamOne
    PEI and Newfoundland June 15, Dynacare and ExamOne
    Manitoba June 15, Dynacare and ExamOne
    Alberta June 18, Dynacare and ExamOne
    British Columbia June 22, Dynacare and ExamOne
    Nova Scotia June 22, Dynacare and ExamOne
    Ontario* By June 30, Dynacare and ExamOne
    Quebec * By June 30, Dynacare and ExamOne
     
    Note: Start dates are subject to change based on the progress of COVID-19.
     
    *Ontario & Quebec to re-open regionally (starting with areas with lower incidence of COVID-19). Specifics for Ontario and Quebec will be communicated closer to the implementation dates for these provinces. Further details can be found in this communication.
  8. Anti-money laundering legislation changes for Savings & Retirement forms and applications
    To comply with the Government of Canada’s anti-money laundering legislation and FATCA/CRS changes, Equitable Life® has updated its Savings and Retirement forms and applications. New online forms and applications are available to download from EquiNet®. Paper applications are also available to order from Equitable’s Supply Team. For a complete list of all forms and applications affected by the anti-money laundering legislation, refer to Anti-money Laundering Legislation Requirements Summary.
     
    What should I do if I have existing paper applications?
    If you currently have paper applications (Form #1383, #1384, #799, #355) with a version date that is before April 2, 2021, Equitable Life will continue to accept them, with the caveat that additional information may be required from you and your client to comply with anti-money laundering legislation.
     
    How long can I use my existing paper applications with a version date before April 2, 2021?
    Paper applications (Form #1383, #1384, #799, #355) with a version date prior to 2021/04/02 (located on the back page and in the bottom right-hand corner of the application) will no longer be accepted after July 1, 2021. If you have applications with a date that is before 2021/04/02, please destroy them and use the fillable/savable PDF on EquiNet. You can also order paper applications from our Supply Team.
     

    Want to be sure you always have the most up-to-date application? Try our EZcomplete® online application platform. EZcomplete makes it easy to process your non face-to-face applications and allows your clients to provide their signature remotely on their own device.
     
    To learn more about the Government of Canada’s anti-money laundering legislation and FATCA/CRS review the following links.
     
    Government of Canada - Guidance on the Common Reporting Standard
    Financial Transactions and Reports Analysis Centre of Canada
     
    If you have any other questions, contact your Regional Investment Sales Manager.
     
    ® denotes a registered trademark of The Equitable Life Insurance Company of Canada.

     
  9. EZtransact Training and Resources
  10. 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.