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Equitable Life Group Benefits Bulletin – February 2022
In this issue:
- Update: Alberta biosimilar coverage changes*
- Preferred Biosimilar Program*
- Responding to Quebec’s biosimilar policy*
- Dental fee guide updates*
- Reminder: Review manual allocations for HCSAs and/or TSAs*
- Mental health resources for plan members*
Update: Alberta biosimilar coverage changes*
In 2022, Alberta’s provincial drug plan is adding four originator biologics to its Biosimilar Initiative. It has ended or will end provincial coverage of these drugs for some or all conditions, as follows:
Four originator biologics added to Alberta Biosimilar Initiative- Lovenox: Jan. 10, 2022
- Humalog: Feb. 1, 2022
- NovoRapid: April 1, 2022
- Humira: May 1, 2022
Patients 18 and over 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.
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 these originator biologic drugs for plan members in Alberta.
Effective May 1, 2022, claimants currently taking these drugs will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable Life plan.
This is a continuation of the Alberta biosimilar switch program we launched last March, when the province first introduced its Biosimilar Initiative.
Do my clients need to take any action?
No action is required by plan sponsors. Plan members taking these targeted originator biologics will be contacted directly to allow them ample time to transition to a biosimilar. Any cost savings associated with the change will be factored in at renewal.
Groups that opted out of the biologic coverage changes we made last March will automatically be opted out of these coverage changes, as well as any future changes to our Alberta biosimilar switch program. This means that their drug plans will continue to provide coverage to existing claimants for any originator biologics we stop covering as part of our biosimilar program.
Advisors with clients who wish to opt out of our Alberta biosimilar program, or who previously opted out and want to opt back in, should speak to their Group Account Executive or myFlex Sales Manager.
Communication to plan members
We will be communicating these coverage changes with affected claimants in early March to allow them ample time to change their prescriptions and avoid any interruptions in their treatment or their coverage. Thus far, the transition to biosimilars, has been smooth and continues to be successful.
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 also biologics. 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.Preferred Biosimilar Program*
As part of our ongoing efforts to help ensure the sustainability of your clients’ drug plans, we continue to engage in strategic partnerships with pharmaceutical manufacturers.
We are pleased to announce a partnership to make Hyrimoz our preferred biosimilar for Humira. This partnership will generate additional savings for plan sponsors.
Plan members will still have the choice to use Humira biosimilars other than Hyrimoz. However, in the absence of alternative sources of reimbursement, this may increase their out-of-pocket amount.
The Preferred Biosimilar Program will take effect March 1, 2022 for all new claimants across Canada who start using a Humira biosimilar. It will take effect May 1 for existing claimants in Alberta who switch to a Humira biosimilar, to align with changes to the provincial plan.
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.Responding to Quebec’s biosimilar policy
Last year, the Quebec government announced it is phasing out coverage of biologic drugs. Beginning April 13, 2022, patients in Quebec using originator biologics will be required to switch to the corresponding biosimilar covered on the province’s public plan in order to maintain coverage.
The following populations are excepted from this new policy:- Pregnant women, who should be transitioned to biosimilars in the 12 months after childbirth.
- Pediatric patients, who should be transitioned to biosimilars in the 12 months after their 18th birthdays.
- Patients who have experienced two or more therapeutic failures while being treated with a biologic drug for the same chronic disease.
We are actively investigating the impact of this new policy on private drug plans in Quebec. We plan to implement further enhancements to our biosimilar programs in Quebec later this year to help prevent this change from resulting in additional costs for our clients’ drug plans. We will provide more details in the coming months.Dental fee guide updates
Each year, Provincial and Territorial Dental Associations publish fee guides. Equitable Life uses these guides to help determine the reimbursement limits for dental procedures. For your reference, below is the list of the average dental fee increases for general practitioners that will be used by Equitable Life for 2022.*
Dental fee guide increases over 2021*
*Data for all provinces and territories was not available at the time of publication. This chart will be updated on EquitableHealth.ca as more information becomes available.Province/Territory Average Fee Increase Alberta 3.9% British Columbia 7.35% Manitoba 5.79% New Brunswick 5.9% Newfoundland and Labrador 5% Nova Scotia 7.05% Northwest Territories 3% Nunavut 3.1% Ontario 4.75% Prince Edward Island 4.75% Quebec 5% Saskatchewan 5.99%
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. Please review all your plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year.
If your clients have Plan Administrator update access on EquitableHealth.ca, they can update these amounts online by doing the following:- 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 “12/31/2020”
- Select “Next”
- Select “Finish”
- View “Report”
Mental health resources for plan members*
As the COVID-19 pandemic continues to evolve, many Canadians are experiencing increased levels of stress, anxiety, and depression. 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. These resources include a number of webinars which discuss various COVID-19 and mental health-related topics. The webinars are pre-recorded so plan members can stream them at their convenience.
Understanding the Impact of COVID-19 on Your Mental Health
English webinar
French webinar
COVID-19: Loneliness & Isolation Fatigue - Self-Care Strategies
English webinar
French webinar
COVID-19: Dealing with Seasonal Affective Disorder
English webinar
French webinar
Reducing Anxiety & Managing the Transition Back to the Classroom - for Teachers
English webinar
French webinar
COVID-19: Specialized Mental Health Support for Health Care Professionals
English webinar
French webinar
COVID-19: Supporting Children’s Mental Health
English webinar
French webinar
Additional resources, including articles, tools, videos and podcasts, are available at Homeweb.ca/Equitable. Please encourage your clients to share these resources with their plan members.
- [pdf] Annuity Settlement Option
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Elevate your business with industry best practices and needs-based selling
Keeping your business aligned with industry best practices is vital for your success. It not only supports the fair treatment of clients – it also helps you meet certain market conduct requirements and Equitable’s expectations for needs-based selling.
The Financial Services Regulatory Authority of Ontario (FSRA) has a program that checks how well advisors follow the Insurance Act and its conduct rules. FSRA looks at how well advisors follow industry best practices and fair treatment of clients guidance (see CLHIA’s guidance document, “The Approach”). Their focus is on key areas such as giving sound advice, managing conflicts of interest, and putting clients’ needs first. FSRA selects advisors’ client files and looks for documentation that indicates needs-based selling.
In December 2024, FSRA released its latest Market Conduct Supervision Report. It highlights the need for advisors to follow certain rules and industry best practices. The report found five key areas where improvement is needed:
1. Missing notes from client meetings and calls
2. Inadequate advisor disclosure
3. Missing sales illustrations for different product options
4. Missing insurance needs analysis
5. Missing policy delivery receipts
By following industry best practices and keeping thorough records, you show your commitment to providing clients with the solutions they need. For example, taking notes during client meetings helps you track all discussions that support your recommendations. Having an insurance needs analysis shows you are providing clients with suitable advice to buy the solutions that best meet their needs.
Resources: Equitable® has resources that can help improve your business practices and help you treat clients fairly. We encourage you to check these out:
1. PPT: “Ensuring a Compliant, Needs-based Insurance Sale”. The steps to follow in needs-based selling and the records to keep.
Get CE credits! We offer the above as a self-study course that qualifies for 1 Continuing Education (CE) credit. Access it here: https://equitable-life-education.teachable.com/. (Use your contracted email to log in).
2. Client File Reference: The records to keep when selling investments, life insurance, or critical illness insurance, including key documents insurers and regulators look for during compliance audits.
3. Investor Profile Questionnaires: These will help you document your sales recommendations for:
● Universal Life (UL) sales: 1190.pdf, and
● Pivotal Select (Segregated Fund) sales: 1165.pdf
Questions? Contact your Equitable wholesaler. They are ready to support your success! - Administration Reference Guide for Individual Wealth
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Excelerator Deposit Option – maximum payment limit changes
The Excelerator Deposit Option (EDO) gives your client the option to make additional payments, subject to specified limits and our current administrative rules and guidelines, above the required guaranteed policy premium. EDO payments can help grow the long-term values in your client’s policy. This change is regarding the maximum EDO payment limit that applies to the policy.
● NEW! If a request is received to terminate, convert, or reduce the term rider and the term rider has been in effect for 10 years or longer, the EDO maximum for the policy will not be reduced.
For Equimax policies with an Owner Signature Date of June 26, 2021 or after where a term rider has increased the maximum EDO payment limit on the policy
● If a request is received to terminate, convert, or reduce the term rider and the term rider has been in effect for less than 10 years (it has not reached the 10th policy anniversary), the EDO maximum for the policy will be reduced accordingly.
Current rules as to when underwriting is required for EDO payments continue to apply, as do current rules surrounding acceptance of EDO payments and maintaining the tax-exempt status of the policy and can be found in the Equimax Product Admin Guide.
Want more information? Contact your Regional Sales Manager for more information on these changes
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February 2020 Advisor eNews
In this issue:
Provincial biosimilar update
Legislative changes for Alberta’s Coverage for Seniors program
Coming soon: enhancements to Equitable EZClaim® Online
Provincial biosimilar update
Alberta Biosimilar Initiative
On December 12, 2019, the Alberta government introduced the launch of the Alberta Biosimilar Initiative. This program will require patients using several originator biologic drugs to switch to a biosimilar, and patients using a non-biologic complex drug (NBCD) to switch to its subsequent entry version before July 1, 2020 in order to maintain coverage.
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” drug. Biosimilars 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.
Alberta Health will initially cover both the originator and biosimilar or subsequent entry version of a NBCD drug as patients start the switching process.
The following table outlines the affected originator drugs, their biosimilars or subsequent entry, and the conditions affected by the program.
Biosimilar Drug Originator Biosimilar/Subsequent Entry Indications Affected etanercept Enbrel Brenzys Ankylosing Spondylitis
Rheumatoid ArthritisErelzi Ankylosing Spondylitis
Psoriatic Arthritis
Rheumatoid Arthritisinfliximab Remicade Inflectra
RenflexisAnkylosing Spondylitis
Plaque Psoriasis
Psoriatic Arthritis
Rheumatoid Arthritis
Crohn’s Disease
Ulcerative Colitisinsulin glargine Lantus Basaglar Diabetes (Type 1 and 2) Filgrastim Neupogen Grastofil Neutropenia pegfilgrastim Neulasta Lapelga Neutropenia glatiramer* Copaxone Glatect Multiple Sclerosis *Glatiramer is a non-biologic complex drug where the originator is Copaxone and the subsequent entry is Glatect.
Equitable Life is actively investigating the benefit, risk and appropriate plan changes associated with this new policy on private drug plans and will keep you informed.
For more information about the Alberta Biosimilars Initiative, consult the Alberta government website.
British Columbia
In 2019, BC Pharmacare introduced a Biosimilars Policy that impacted coverage of three biologic drugs – Remicade, Enbrel and Lantus. As of November 25, 2019, these drugs were no longer eligible in BC for most conditions for which lower cost biosimilar versions are available. Patients in the province with these conditions were required to switch to biosimilar versions of these drugs in order to maintain their coverage.
The second phase of the BC Biosimilar Policy takes effect March 6, 2020 when Remicade will be delisted for Crohn’s Disease and Ulcerative Colitis. Patients in the province with these conditions will be required to switch to Inflectra or Renflexis in order to maintain their coverage.
Biosimilar Drug Originator Biosimilar Indications Affected infliximab Remicade Inflectra
RenflexisCrohn’s Disease
Ulcerative ColitisWe have communicated with the affected plan members, informing them of the need to switch medications. If plan members have any questions or concerns, our Customer Care team is here to help and support them through the transition.
If you have any questions about this policy, please contact your Group Account Executive or myFlex Sales Manager.
Ontario
In November 2019 Ontario Minister of Health Christine Elliot indicated that the government was planning to launch consultations to explore solutions in managing biologics.
Equitable Life will continue to monitor these developments and keep you informed of any impact on private drug plans.
Legislative changes for Alberta’s Coverage for Seniors program
The government of Alberta has announced that as of March 1, 2020, seniors’ family members (such as spouses and dependents) who are younger than 65 will no longer be covered by the provincial Coverage for Seniors program. Albertans 65 years of age and older will continue to be covered under the provincial plan.
Equitable Life plan members and their dependents will continue to be covered under the parameters of their group benefits plan.
For more information, please see the Alberta Seniors Health Benefits website.
Coming soon: enhancements to Equitable EZClaim® Online
Faster vision claims processing and payment
Equitable Life will soon provide real-time processing of vision claims submitted via EZClaim Online.
This means plan members will be able to find out the status of their vision claim almost instantaneously. And, for approved claims, they will receive payment even sooner – often in as little as 24 hours.
In order to allow for instantaneous processing and faster payment, plan members will be prompted to enter some additional information including the practitioner’s name, the date of the expense, the type of expense and amount of the expense when submitting their claims for these services.
Equitable Life plan members can submit all vision claims via EZClaim, including coordination of benefits and Health Care Spending Account claims.
This enhancement will be coming to our EZClaim Mobile app in the coming months.
New printable claims extract
As part of our ongoing efforts to improve customer experience for plan members, we will also offer a claims extract in a printable format within the plan member site. Plan members will be able to select a date range and claimant, then generate and download a detailed list of health and dental claims. This is a helpful way to keep track of claims, especially when reviewing them in preparation for income tax filing.
Once these enhancements are live you will be notified in an eNews, and an announcement will be posted on the plan member section of EquitableHealth.ca.
Elimination of Out-of-Country Travellers Program in Ontario
Effective January 1, 2020, the Ontario government eliminated OHIP coverage for emergency services for Ontarians travelling outside of Canada.
Previously, the Out-of-Country Travelers Program provided some reimbursement for services required to treat conditions that are acute, unexpected, arose outside Canada and require immediate treatment. The program covered between $200 and $400 per day for inpatient services and $50 per day for outpatient and doctor services.
For groups who have out-of-country coverage from Allianz, this change will not impact the cost to your plan members, or the process plan members follow in the event of an emergency while travelling.
Plan members should still call Allianz in the event of an out of country emergency. Allianz will deal with their claim as usual and will now pay for the portion of the claim previously paid by OHIP. Plan members will not have any additional out-of-pocket costs.
We will be sharing this information with plan members as a news item on our plan member website, equitablehealth.ca.
- Equitable and Cloud DX
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Reminder: Deadline to opt out of Alberta biosimilar coverage changes
In November 2020, we announced via eNews that on March 15, 2021, we are changing coverage for some biologic drugs in Alberta in response to the province’s Biosimilar Initiative. These changes will help protect your client’s plans from additional drug costs while still providing access to equally safe and effective biosimilars.
Do my clients need to take any action?
Traditional groups who wish to opt out of this change and maintain coverage of these originator biologics for Alberta plan members can submit a policy amendment. Amendments must be submitted no later than January 15, 2021.
Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for Alberta plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.
Otherwise, no action is required on their part. Plan members taking these biologics will be contacted directly to allow them ample time to change their prescription. Any cost savings associated with the change will be factored in at renewal.
Questions?
We have compiled a list of frequently asked questions to help you understand Alberta’s Biosimilar Initiative. If you have a question that isn’t answered here, please contact your Equitable Life Group Account Executive or myFlex Sales Manager.
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Saving time with our fully digital group benefits application
On May 1, 2023, we are launching Equitable BenefitsApply™, our fully digital group benefits application.
This enhancement to the benefits application process will help both you and your clients save time when applying for an Equitable Life group benefits policy. We designed and developed BenefitsApply with input and feedback from several advisors and clients, who tested the tool for themselves.
In most cases, BenefitsApply will replace our traditional paper implementation process.*
BenefitsApply eliminates the need for clients to complete and sign multiple, lengthy paper forms. Time-saving features for you and your clients include:- A fully digital online application that you can access wherever and whenever you need it,
- Pre-filled standard fields,
- Only one signature required from plan sponsors,
- A smart application that only includes the sections relevant to the client and the plan design they have chosen, and
- Automatic notifications of any missing fields.
We will continue improving BenefitsApply’s features based on feedback from the people who use it—you and your clients. We encourage you to share any feedback you have with your Group Account Executive or your Client Relationship Specialist.
*BenefitsApply is currently available for groups with up to four divisions and up to four classes. It is not available for myFlex Benefits plans, or for clients with a customized master application. -
Clients could win $5,000 in Equitable’s New Year’s Resolution, New Year’s Contribution Contest!
Equitable® wants to help clients achieve their financial goals in 2024.If they win, you win! The draw will be held March 20, 2024.
Clients could win $5,000 and you could win $1,000 in Equitable’s New Year’s Resolution, New Year’s Contribution Contest.
How it works:
The client makes a contribution between January 1 and February 29, 2024 to one or more of these accounts:
Equitable is dedicated to offering clients the products, the services, and the choices that best suit their needs. We provide multiple sales charge options, three distinct guarantee classes, and a diverse selection of investment funds.
Speak to your Regional Investment Sales Manager to learn more.
Posted: December 14, 2023
® denotes a registered trademark of The Equitable Life Insurance Company of Canada.
Equitable’s New Year’s Resolution, New Year’s Contribution Contest: No purchase necessary. Contest period January 1, 2024, to February 29, 2024. Enter by making a deposit to an Equitable FHSA, TFSA or RRSP during the contest period or by submitting a no-purchase entry. One prize for a total value of $5,000 CAD to be drawn on March 8, 2024, will be awarded. The servicing advisor for the policy to which the selected entrant 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 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.