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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.
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Equitable Life Group Benefits Bulletin - October 2022
Introducing new Gender Affirmation Coverage for group benefits plans
Providing an inclusive benefits plan can play a critical role in fostering a workplace culture that welcomes diversity and helps employees thrive. While most provinces cover the cost of gender-affirming surgery, each person has unique needs. Some may require procedures that are not publicly covered.
That’s why we’re pleased to introduce a new coverage option for gender affirmation surgical procedures that are not covered by provincial health plans. Gender Affirmation Coverage helps plan sponsors to close the gap where provincial health coverage ends.Coverage details and eligibility
Gender Affirmation Coverage can be added to any Equitable Life plan with an in-force Extended Health Care plan. It provides coverage for gender-affirming procedures that are not covered by provincial health plans. This might include tracheal (Adam’s apple) shaving and voice surgery. It will also cover some additional procedures to further align the plan member’s features to the transitioned gender, such as facial bone reduction and cheek augmentation. This makes a wider variety of gender-affirming surgeries accessible to plan members and helps minimize their out-of-pocket costs.
Plan members are eligible for coverage with a diagnosis of gender dysphoria from a qualified health care professional.Offering a more inclusive benefits plan
The coverage provides one more way for your clients to offer more inclusive coverage and to offer holistic support to their plan members undergoing a gender transition. We have developed this coverage as a complement to our existing coverage options, including Health Care Spending Accounts (HCSAs), Taxable Spending Accounts (TSAs), Extended Health Care and drug coverage, and Employee and Family Assistance Programs, all of which can provide support to plan members undergoing gender affirmation.
We regularly review our products to ensure that they’re meeting your clients’ needs, and we’re committed to offering products that support diversity, equity and inclusion.
We also continue to review our forms, documents and processes to make them more inclusive. This includes reviewing our online plan member enrolment (OPME) tool to allow for more flexibility with the way plan members identify their gender.Gender affirmation and mental well-being
Gender affirmation procedures can lead to improved mental health outcomes for those with gender dysphoria, as most report an improvement in their quality of life following the procedures. Gender dysphoria may occur when a person’s assigned sex at birth does not match their identity, and people experiencing gender dysphoria typically report psychological and emotional distress, including symptoms of depression or anxiety. By offering coverage where provincial health coverage ends, your clients can support plan members as they seek procedures that align their body presentation with their self-identified gender.
Advantages at a glance
Advantages for plan members include:- Reimbursement for some procedures and expenses, leading to fewer out-of-pocket costs
- May experience improved mental health outcomes after surgery
- A benefits plan that promotes a culture of diversity, equity and inclusion, which may build employee loyalty
- Support for plan member mental health to help those with gender dysphoria thrive
The Benefits Canada 2022 Health Care Survey results are in!
Equitable Life is proud to be a Platinum sponsor for The Benefits Canada 2022 Health Care Survey, Canada’s leading survey on workplace benefits plans. This year’s survey report highlights many fascinating insights across a wide variety of benefits topics, including:- A focus on mental health for both plan sponsors and plan members
- The repercussions of the "shadow" pandemic due to health care delays
- Trends in plan members' overall perceptions of their health benefits plans
- The types of benefits getting more attention from plan members
- The role of remote work in plan member satisfaction
We’re committed to helping you and your clients navigate the evolving landscape of employee benefits in Canada by contributing to this vibrant industry community. To read the full report, visit Benefits Canada.
HCSA and TSA manual allocation reminder
If your clients’ Health Care Spending Account (HCSA) and/or Taxable Spending Account (TSA) have manual allocations, they need to allocate these amounts to plan members each year. Clients should review their plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year. Your clients may also order HCSA and TSA forfeiture reports on EquitableHealth.ca.
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 12/31/2022
- Select Next
- Select Finish
- View Report
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Easier group enrolment and more group benefits updates
Make enrolment easier for your clients with online plan member enrolment (OPME)
Enrolling new plan members can be overwhelming – for both you, your clients and their employees. It’s time-consuming to manually load new members and challenging to ensure they complete the necessary paperwork before the enrolment deadline.
Our Online Plan Member Enrolment (OPME) tool is available at no extra cost for all your Equitable Life clients and offers a more secure and efficient alternative to traditional paper enrolment. Using their computer or mobile device, employees can enrol in their benefits plan in just minutes.
The user-friendly tool allows plan members to easily enter all their enrolment information, including:- Dependent details
- Banking information for direct deposit of claim payments
- Details for coordination of benefits
- Beneficiary designation
The days of chasing plan members for their paper enrolment forms are gone. Once plan administrators enter a few employee details, our system automatically sends an email to each plan member, inviting them to enrol in their benefits program. And there will be no need for your clients to send reminders or follow up with employees about their benefits enrolment. It’s all done automatically.Support with using OPME
To learn more about the benefits of using OPME, check out our Online Plan Member Enrolment Flyer. We also encourage you to share more information with your clients: We also have helpful reference guides for plan members, to help them use the tool:- Online Plan Member Enrolment Quick Reference Guide
- myFlex Online Plan Member Enrolment Quick Reference Guide
Help your clients spend less time administering group benefits. Contact your Group Account Executive or myFlex Sales Manager to learn more about our online plan member enrolment.
Coming soon: A survey to help us serve your clients better*
We are committed to providing your clients and their plan members with industry-leading service. We’ve introduced several enhancements over the past year to make it easier to do business with us. And we’re continually looking for ways to improve.
This month, we will conduct a survey of your clients to help us understand how we can better serve them. Plan administrators will receive an email with a link to the survey, which will take between five and 10 minutes to complete.
Please encourage your clients to participate. Their feedback will be confidential, and their responses will help us improve our service and ensure we’re meeting their expectations. We will also allow them to provide their name so that we can follow up with them to address any concerns they’ve identified.
We know your clients’ time is valuable. So, each plan administrator who completes the survey will be entered into a random draw for a chance to win one of 3 prepaid gift cards for $200.
Improved mental assessment features for FeelingBetterNow®*
Mensante has enhanced its FeelingBetterNow® online platform to make it easier for plan members to assess the state of their mental health and talk to their health care provider about treatment options. FeelingBetterNow is part of our Equitable HealthConnector suite of wellness solutions and is available for an additional cost. It can help plan members easily identify if they are at risk for a number of common mental health issues, including depression, anxiety and substance abuse.Upgrades to the platform include:
- New features to help plan members better gauge their progress in the assessment.
- A printable Action Plan that plan members can share with their health care provider to initiate conversations about managing their mental health challenges.
- A new “follow-up” module to help plan members assess the care they’ve received from their health care provider and identify care gaps.
- An Assessment Outcome Page, which allows plan members to view their diagnostic risks across mental health disorders for a more holistic picture of their health.
Over-age dependants losing coverage?*
Your clients’ plan members may have dependants approaching the maximum age for eligibility under their group benefits plan. If so, members should be aware of their options for dependant coverage.Coverage for full-time students and dependants with disabilities
The dependants of your clients’ plan members may be eligible to continue their coverage under the current plan if:- The dependant is attending a post-secondary school full-time; or
- The dependant is disabled.
Coverage2go for over-age dependants
Dependants who aren’t eligible for continued coverage under the plan can apply for Coverage2go®, a month-to-month health and dental plan for individuals losing their group coverage.**
Coverage2go is affordable, reliable and allows the over-age dependants to choose the level of coverage and protection that suits their personal situation. With no medical questions required as long as they apply within 60 days of losing their coverage, your clients’ plan members can ensure that their over-age dependants have the coverage they need.
Plan members can receive a quote within minutes. Please direct your clients to Coverage2go on Equitable.ca to learn more.
**Quebec residents are not eligible for Coverage2go.Forfeiture reports for HCSAs and TSAs on EquitableHealth.ca*
As a reminder, your clients can access forfeiture reports for their Health Care Spending Account (HCSA) and Taxable Spending Account (TSA) usage on EquitableHealth.ca.HCSA summary by plan member
HCSA summary reports provide an overview of each plan member’s account activity and balances. These reports include the total amounts allocated, the amount claimed to date, the net balance, and the amount of funds that will be forfeited based on claims paid to date. Please note that plan members’ claim submissions will remain confidential and will not be viewable by the employer on this summary.
Your clients can provide each plan member with their HCSA summary, if they wish.HCSA account forfeiture by plan member
HCSA forfeiture reports detail the amount that each member will forfeit if they do not use it. The amount is based on claims that have been paid to date within the benefit year period.HCSA account totals by plan member
Your clients may wish to access the HCSA account totals reports, which reflect the information in each plan member’s HCSA summary report. For terminated employees, the Funds Available field will display as zero, regardless of the balance in the account when terminated.
At least three months before the end of the benefits period, your clients should remind their members to use their allocated HCSA and TSA amounts.
If your clients need help accessing these reports, they can reach out to their Regional Office Service team for assistance.
* Indicates content that will be shared with your clients.
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May 2026 eNews
In this issue:
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Save the date: Group benefits advisor roadshow is returning to a city near you
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One-time passcodes will be added to our login experience this week*
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Delisted service providers: What clients need to know*
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Keeping plan member information up to date*
*Indicates content we will share with your clients.
Save the date: Group benefits advisor roadshow is returning to a city near you
Mark your calendars—our annual group benefits advisor roadshow will be travelling across Canada this fall.
Watch your inbox for an invitation with more details soon. In the meantime, here’s our full list of event dates and cities.
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Monday, Sept. 28 – Vancouver, BC
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Tuesday, Sept. 29 – Edmonton, AB
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Wednesday, Sept. 30 – Calgary, AB
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Thursday, Oct. 1 – Saskatoon, SK
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Friday, Oct. 2 – Winnipeg, MB
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Tuesday, Oct. 6 – Halifax, NS
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Wednesday, Oct. 7 – Ottawa, ON
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Thursday, Oct. 8 – Markham, ON
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Tuesday, Oct. 20 – London, ON
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Wednesday, Oct. 21 – Kitchener, ON
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Thursday, Oct. 22 – Oakville, ON
One-time passcodes will be added to our login experience this week
Starting next week, anyone who logs in to EquitableHealth.ca® or the Equitable EZClaim® mobile app with an email address and password may also need to enter a one-time passcode to access their account. The one-time passcode will be provided by email.
Adding this form of multi-factor authentication (MFA) to our login process will further enhance our digital security and help safeguard your account and our clients’ personal data.
Don’t forget—you can create a passkey instead.
Passkeys are another form of MFA. They provide a quick, easy and secure way to access your account, using either biometrics—your face or fingerprint—or a PIN authenticator to confirm your identity.
Anyone who uses a passkey to log in to their account will never be required to enter a one-time passcode.
In case you get questions…
If a client asks you about these changes to our login process, consider sharing this fact sheet with them. The fact sheet highlights the value of adding MFA to the login process and describes the differences between logging in with a one-time passcode versus a passkey.
More information about one-time passcodes and passkeys is included at equitable.ca/effortless. There, you’ll also find short videos that show how easy it is to create a passkey on your mobile device and computer.
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.
Delisted service providers: What clients need to know
Protecting clients’ group benefits plans is our priority. That’s why we regularly assess healthcare service providers, clinics, facilities and medical suppliers in our network. These reviews help ensure the claims plan members submit meet eligibility requirements.
If our review indicates a provider is not meeting those requirements, we may delist them.
Common reasons we delist providers include:
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Billing for services that weren’t provided or aren’t medically required
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Changing information about treatments provided (e.g., service dates or patient names)
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Incomplete records or treatment notes
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Lack of cooperation with an audit
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Suspension of the provider by their licensing college or association
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Criminal convictions
What clients need to know
If a provider is delisted, we will not accept or process claims for services or supplies they provide. However, plan members can still choose to use delisted providers at their own expense.
We provide clients instructions on where to find our current list of delisted providers in each Plan Administrator eNews announcement. We also encourage them to share the list with their plan members.
Whenever we delist a provider, we try to contact plan members, who have recently submitted claims for their services, to inform them of the change and help prevent future claim submissions. However, plan members are responsible for checking our list of delisted providers before purchasing any product or service to avoid having to pay at their expense. The list is available on EquitableHealth.ca.
If you have questions about our list of delisted service providers or our process of reviewing providers, please contact your Group Account Executive.
Keeping plan member information up to date
Keeping plan member information current helps ensure accurate benefits coverage and premium calculations.
When a plan member’s earnings or occupation changes, the plan administrator must update this information as soon as possible. Updates made before a benefits plan renewal helps ensure renewals are based on current data.
If a plan includes short-term disability (STD) or long-term disability (LTD) benefits, outdated earning information can affect disability claim payments for plan members.
We send an annual reminder to plan administrators before renewal. The email includes step-by-step instructions on how to review and update plan members’ earnings and occupation information.
Three ways to update earnings and occupation information
Plan administrators can review and update plan members’ information by either:
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Making updates directly through the plan administrator site (update access required),
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Generating an earnings and occupations worksheet through the plan administrator site (online reporting access required), or
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Requesting a worksheet by emailing groupbenefitsadmin@equitable.ca.
The worksheet includes instructions on how to submit completed updates to us. If you have any questions, please contact your Client Relationship Specialist or email groupbenefitsadmin@equitable.ca.
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