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Short-term disability coverage for plan members in quarantine or self-isolation*
Please note: This announcement applies only to groups with short-term disability coverage through Equitable Life

With the spread of COVID-19, many people have been instructed to self-isolate or quarantine themselves or are doing so voluntarily. We realize this is a stressful situation for people and they may be wondering if they are eligible for disability benefits. Short-term disability is designed to replace a plan member’s earnings if they are unable to work due to illness and injury. As a result, only plan members who meet the following criteria are eligible for benefits:
- Plan members who have tested positive for COVID-19 and are unable to work from home are eligible for coverage from Day 1 of their self-isolation period.
- Plan members who have not been tested but have symptoms consistent with COVID-19 and are unable to work from home, are eligible for coverage. Claims will be assessed according to the terms of the plan.
Plan members who are in quarantine for any other reason, but do not have symptoms consistent with COVID-19, are not eligible for coverage. These plan members should consider applying for Employment Insurance (EI) benefits, if they do not have an option to work from home.

Submitting COVID-19-related STD claims

To make things easier for plan members who need to submit claims related to COVID-19, we will not require a physician’s statement. Instead plan members should submit our simplified Short Term Disability Plan Member COVID-19 Claim Form.

Plan Administrators need to complete their portion of the regular Short Term Disability Form (Form #421).

This is a temporary process that will remain in effect through the current coronavirus situation. We will update on changes and share them on EquitableHealth.ca.

Applying for the Employment Insurance sickness benefit

Canadians quarantined due to COVID-19, who are not receiving Short Term Disability benefits, can apply for Employment Insurance (EI) sickness benefits. The one-week waiting period for EI sickness benefits has been waived. Service Canada’s dedicated toll-free support number is 1-833-381-2725 or (TTY) 1-800-529-3742.

*Indicates content that will be shared with your clients
Equitable Life Group Benefits Bulletin – January 2022
Short-term disability coverage for plan members with COVID-19*
Please note: This announcement applies only to groups with short-term disability coverage through Equitable Life

As the COVID-19 pandemic continues, and the situation evolves, we continue to adjust our practices to ensure ongoing support for our plan members.

PCR tests no longer required for COVID-related STD claims

Some provinces have recently restricted access to COVID-19 PCR testing to only high-risk individuals. To ensure your clients' eligible plan members receive their short-term disability benefits in a timely manner, we no longer require a positive PCR test for plan members submitting COVID-19-related STD claims.

Plan members who are experiencing symptoms of COVID-19 or who have tested positive for the virus (either with a PCR test or with an at-home rapid test) and are unable to work from home should complete the Short Term Disability Plan Member COVID-19 Claim Form (#421A).

They should indicate the date of the onset of symptoms or date of their positive test result. Where applicable, they should also indicate the date they have been cleared by public health to end their self-isolation. The form includes an attestation that the information they have provided is accurate.

The employer needs to complete the Short Term Disability Employer COVID-19 Claim Form (#421B). They should indicate the expected return-to-work date according to their provincial health guidelines, or using the date provided by a public health official.

Waiting periods for COVID-related STD claims

To support your clients' plan members during the initial stages of the pandemic, we waived the STD waiting period if a plan member’s absence was due to symptoms or a diagnosis of COVID-19. Now that COVID-19 has become the “new normal,” we are returning to our standard practices and treating the virus as we would any other illness.

Effective Jan. 1, 2022, standard waiting periods will apply for COVID-related STD claims, according to the terms of the Group policy. This ensures that all plan members submitting a STD claim are treated fairly, no matter what the cause of the claim.

Eligible plan members will receive STD benefits up to a maximum of 10 days from the date of the onset of symptoms or a positive COVID-19 test result, minus the waiting period.

For example, if the plan has a five-day waiting period, and the plan member returns to work nine days after a positive test result, they would be eligible for four days of benefits payments.

If the claimant is still unwell after 10 days, then the standard Short Term Disability Claim Form (#421) needs to be completed.

If a plan member is admitted to hospital, benefits will be paid following the waiting period applicable to hospital claims.
Preferred life insurance solutions – individuals

Responding to Alberta's Biosimilar Initiative

Beginning 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 clients from additional drug costs that may result from this new government policy while still providing access to equally safe and effective biosimilars.

What is Alberta’s Biosimilar Initiative?

Alberta’s Biosimilar Initiative will end provincial coverage of several originator biologic drugs for some or all conditions beginning on Jan. 15, 2021. 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.

What is the impact on private drug plans?

Industry response to Alberta’s Biosimilar Initiative has the potential to significantly impact your clients’ drug plan costs. 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. (See Case Study below.)

How is Equitable Life responding?

To protect your clients’ plans from paying additional and avoidable drug costs, we are changing coverage in Alberta for most biologic drugs included in the provincial initiative.

As of March 15, 2021, several originator biologic drugs will no longer be covered for plan members of all ages in Alberta. Plan members taking these biologics will be required to switch to the biosimilar versions of these drugs to maintain eligibility under their Equitable Life plan.

What drugs and conditions are affected?

The following table outlines the drugs and conditions that will be affected by this change. The list of affected drugs or conditions is dynamic and will change as Alberta includes more biologic drugs in its Biosimilar Initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.

Drug name	Originator biologic These drugs will no longer be covered in Alberta for the conditions listed in this table.	Biosimilar Plan members will need to switch to these medications to maintain coverage under their Equitable Life plan.	Affected health conditions The changes in coverage apply to these conditions.
Etanercept	Enbrel	Brenzys Erelzi	Ankylosing Spondylitis Rheumatoid Arthritis Polyarticular juvenile idiopathic arthritis (JIA) Psoriatic Arthritis Plaque Psoriasis (adults and children)
Infliximab	Remicade	Inflectra Renflexis Avsola	Ankylosing Spondylitis Plaque Psoriasis Psoriatic Arthritis Rheumatoid Arthritis Crohn's Disease (adults and children) Ulcerative Colitis (adults and children)
Insulin glargine	Lantus	Basaglar	Diabetes (Type 1 and 2)
Filgrastim	Neupogen	Grastofil Nivestym	Neutropenia
Pegfilgrastim	Neulasta	Lapelga Fulphila Ziextenzo	Neutropenia
Glatiramer*	Copaxone	Glatect TEVA-Glatiramer Acetate	Multiple Sclerosis

*Glatiramer is a non-biologic complex drug.

How will Equitable Life communicate this change to plan members?

We will be communicating with affected claimants in January 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?

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.

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.

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.

CASE STUDY: The Alberta Biosimilar Initiative and Coordination of Benefits (CoB) risk

CoB risk is real and can be significant, even if a pharmaceutical savings program exists.

The industry response to Alberta’s Biosimilar Initiative has the potential to significantly impact your clients’ drug plan costs. Some insurers may follow the province’s lead and delist these originator biologics. Others may cut back coverage to the cost of the biosimilars or maintain coverage of the originators. These differences could expose a plan that doesn’t delist the originator biologics to significant coordination of benefits risk. Here’s how:

Let’s assume there are two private drug plans – Plan A and Plan B. Both plans are open plans with no deductible. Plan A has 80% co-insurance and Plan B has 100% co-insurance.

BEFORE Alberta’s Biosimilar Initiative

Before Alberta’s Biosimilar Initiative, both plans cover the originator biologics listed above.

Plan A is the first private payer for an Alberta plan member taking an originator biologic drug for Rheumatoid Arthritis. Plan B is the second private payer. The cost of the originator biologic for the plan member is $30,000 annually. Here’s how the coordination of benefits would look before Alberta’s Biosimilar Initiative.

AFTER Alberta’s Biosimilar Initiative

In response to Alberta’s Biosimilar Initiative, the insurer for Plan A delists the originator biologic and requires plan members to switch to the biosimilar. The insurer for Plan B maintains coverage of the originator biologic. Under this scenario, if the plan member doesn’t switch, Plan B essentially becomes the first payer and sees their annual cost increase by 400% (from $6,000 to $30,000).

Even if the insurer for Plan B cuts back coverage to the cost of the biosimilar or adjusts the paid amount because they have a savings program in place with the drug manufacturer, the impact could be significant. For example, if the insurer cuts back coverage to 50% (or $15,000 annually), Plan B would see a 150% annual cost increase (from $6,000 to $15,000):

REMINDER that paper applications with a version date prior to 2021/04/02 are set to expire July 1, 2
To comply with the Government of Canada’s anti-money laundering legislation and FATCA/CRS changes, Equitable Life® has updated its Savings and Retirement and Life Insurance applications.

If you currently have applications with a version date before 2021/04/02, please destroy them and use our online pdf applications or order new applications from our Supply Team. Paper applications 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 for:

● Savings and Retirement (Form #1383, #1384, #799, #355), and
● Life Insurance (Form #350)

Want to be sure you always have the most up-to-date application? Try our EZcomplete® online platform for Individual Life, Critical Illness and Segregated fund applications.

For a complete list of all forms and applications affected by the anti-money laundering legislation, refer to the following links:

● Savings and Retirement Anti-money Laundering Legislation Requirements Summary.
● Life Insurance Anti-money laundering Legislation Requirements Summary.
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 Sales Manager or Equitable Life’s Advisor Services Team

® denotes a registered trademark of The Equitable Life Insurance Company of Canada.
October 2019 Advisor eNews
Coverage of Remicade, Enbrel and Lantus in BC
As we announced in August, BC PharmaCare recently introduced a new Biosimilars Initiative that ends coverage of three biologic drugs, including Remicade, Enbrel, and Lantus. These drugs will no longer be eligible in British Columbia for most conditions for which lower-cost biosimilar versions are available. Patients in the province with these conditions will be required to switch to biosimilar versions of these drugs by Nov. 25, 2019 in order to maintain their coverage under BC PharmaCare. Patients taking Remicade for Crohn's Disease or Ulcerative Colitis will not be required to switch to a biosimilar until March 6, 2020.

Biologics are drugs that are engineered using living organisms, such as yeast and bacteria. Biosimilars are highly similar to the originator drugs they are based on and most have been shown to have no clinically meaningful differences in safety or efficacy.

To ensure this provincial change doesn’t result in your clients’ plans paying additional drug costs, we have aligned our drug eligibility for these three biologic drugs with that of BC PharmaCare.

As previously announced, effective Nov. 25, 2019, Remicade and Enbrel will no longer be eligible for BC plan members with conditions for which lower-cost biosimilar versions of the drugs are available. These plan members will be required to switch to the biosimilar versions of these drugs in order to maintain eligibility on the Equitable Life drug plan. We have communicated with Plan Administrators about this change, and we have informed affected claimants of the need to switch medications.

As well, effective Feb. 3, 2020, the drug ingredient cost for Lantus will no longer be eligible for BC plan members; only the dispensing fee may be eligible under their Equitable Life plan. Plan members taking Lantus will be required to switch to Basaglar, the lower-cost biosimilar version of the drug, in order to maintain coverage under their Equitable Life plan. We will be communicating with Lantus claimants in the coming weeks to allow them ample time to change their prescription and avoid any interruptions in their treatment or their coverage.

If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
De-listed service providers
As part of our ongoing initiative to have Group Benefits plans only reimburse eligible claims, we conduct reviews of the billing and administrative practices of service providers, including clinics, facilities and medical suppliers.
As a result of these reviews we may de-list certain providers. We will no longer accept, or process claims for services and/or supplies obtained from those providers. The plan member can still choose to obtain services or supplies from these providers, but Equitable Life will not provide reimbursement for the claims.

Review Equitable Life’s de-listed service providers

The delisted service provider list is also posted on EquitableHealth.ca for plan members to review to determine if their claim(s) are eligible for reimbursement under their Group Benefits plan.

For more information about protecting group benefits plans from abuse, check out our articles.
EZcomplete no longer accessible on Internet Explorer
On February 25, 2021, Equitable Life’s® EZcomplete® e-signature capability, OneSpan, will no longer be accessible using Internet Explorer (IE) browser. This means that advisors and clients should default their browsers to Google Chrome, Firefox, Edge, or Safari.

If clients try to e-sign the application in IE, they will be redirected to an error page. Advisors will receive a warning. The warning will confirm that IE is no longer supported. To ensure a smooth EZcomplete experience, advisors should consider changing their browser default.

If you have any questions about this change, contact your Regional Investment Sales Manager or Life Regional Sales Manager.
Questions about eDelivery? New eDelivery page
Find information on the eDelivery process quickly with our new eDelivery of a Contract landing page.

We’ve made it easier to get the information you need to electronically deliver the insurance contract promptly.

eDelivery makes it quick and easy, and our new landing page ensures you’re able to find the information you need regarding the New Business eDelivery process, or the Policy Change and Conversions eDelivery process. You can find various resources in the Links section on the right-hand side of each page to help you along the way.
How can I help to expedite the contracting process?
Can an advisor transfer their contract under another MGA?