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Equitable Life Group Benefits Bulletin – September 2021
In this issue:
- Right drug, right dose*
- Responding to New Brunswick’s Biosimilar Initiative*
- Helping plan members access our convenient digital options*
- Reminder: Please access forms on EquitableHealth.ca*
- Over-age dependents losing coverage?*
Right drug, right dose
Equitable Life partners with Personalized Prescribing Inc. to help plan members avoid treatment trial and error
Patients suffering from mental health conditions often need to try several medications before they find one that works for them. This is frustrating and can result in negative side-effects, a longer recovery, lost productivity, or a delayed return to work.
To help plan members avoid this treatment trial and error, we have partnered with Personalized Prescribing Inc. to provide easier access to pharmacogenomic testing for plan members with mental health conditions.
Pharmacogenomics 101
Pharmacogenomics is the study of how an individual’s genes influence their response to medications. Pharmacogenomic testing can help determine how compatible a patient’s body may be to a particular drug, and helps their physician prescribe the most appropriate medication. The goal is to ensure the right drug is prescribed to deliver the most positive outcome with the fewest side effects.
Easier access to pharmacogenomic testing
Through our partnership with Personalized Prescribing Inc., any Equitable Life plan member diagnosed with a mental health condition can purchase a pharmacogenomic test for a discounted price of $399 plus HST – a 20% savings.
We are also introducing the option for plan sponsors to add coverage of pharmacogenomic tests provided by Personalized Prescribing Inc. for mental health conditions.
With this coverage, plan members are eligible for pharmacogenomic testing if:- They have been diagnosed with a mental health condition;
- They are currently taking or have stopped taking a medication for a mental health condition that does not work or has side effects; and
- The pharmacogenomic test is conducted by Personalized Prescribing Inc.
Getting a test is easy. The plan member starts by visiting www.personalizedprescribing.com/equitablelife to request a test kit.
Once they receive their test kit from Personalized Prescribing Inc., they simply provide a saliva sample and send it back (postage is pre-paid). Within 7-10 business days, they receive an Rx Report™ that they can share with their doctor. This report includes details to help their doctor prescribe the right drug and the right dose for them.
Benefits for plan members:- The plan member and their physician receive a full report that is easy to understand;
- The report identifies the most compatible medications for the plan member’s condition and the medications to avoid;
- The physician is able to prescribe the most appropriate medication with the fewest side effects; and
- The plan member avoids medication trial and error.
- Pharmacogenomic testing can be an effective prevention strategy to help employees stay healthy and potentially avoid a mental health-related work absence; and
- Employees suffering from mental health conditions may be more productive when they are on the right medication for them.
Responding to New Brunswick’s Biosimilar Initiative
We are changing coverage for some biologic drugs in New Brunswick in response to the province’s Biosimilar Initiative. These changes will help protect your clients from additional drug costs while still providing access to equally safe and effective biosimilars.
What is New Brunswick’s Biosimilar Initiative?
New Brunswick’s Biosimilar Initiative will end provincial coverage of several originator biologic drugs for some or all conditions beginning on December 1, 2021. Patients 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?
The most significant risk to plan sponsors who maintain coverage of originator biologics is coordination of benefits (CoB) risk. 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.
For example, consider a patient who is covered under two private plans – their employer plan and a spousal plan. If their employer plan was the first payer for the originator biologic but delists the drug, the spousal plan now becomes the first payor. If the spousal plan continues to cover the cost of the originator, it now pays most or all of the cost of the drug.
How is Equitable Life responding?
To protect your clients’ plans from paying additional and avoidable drug costs, we are changing coverage in New Brunswick for most biologic drugs included in the provincial initiative.
Beginning Feb. 1, 2022, plan members in New Brunswick will no longer be eligible for coverage of Humira, Lantus, Humalog and Copaxone 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 those drugs to maintain coverage under their Equitable Life plan.
How will Equitable Life communicate this change to plan members?
We will be communicating with affected claimants in early-December 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?
All groups, except myFlex clients, who wish to opt out of this change and maintain coverage of these originator biologics for New Brunswick plan members can submit a policy amendment. Amendments must be submitted no later than Nov. 30, 2021.
Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for New Brunswick plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.
Groups that opt out of this change are also opting out of any future changes to our New Brunswick biosimilar initiative. Their drug plans will continue to cover any additional originator biologics that we subsequently add to the program.
Will this change impact my clients’ rates?
The rate impact of this change and 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.
Helping plan members access our convenient digital options
Some of your clients’ plan members aren’t benefitting from our secure and convenient digital options to access and use their Group Benefits. They can sign up to submit claims electronically for faster claim payments, get claim payments deposited directly to their bank accounts, easily review their coverage details, quickly access their Group Benefits plan booklet, benefits card and more. We’ve made it easier than ever to sign up, with more resources all conveniently located at Equitable.ca/go/digital.
Your clients’ plan members can visit this link to view:- A brochure with all the high-level instructions they need to get started on EquitableHealth.ca and the EZClaim mobile app
- A full video guide on how to access and navigate EquitableHealth.ca
Reminder: Please access forms on EquitableHealth.ca*
We routinely update our Plan Administrator forms on EquitableHealth.ca based on their feedback and to stay compliant with legal and/or regulatory requirements. If your clients need a form, they should always pull the most recent version from EquitableHealth.ca instead of reusing forms they have saved on their computer. Using an old or outdated form may result in processing delays.
Your clients can access the Plan Administrator forms by following these steps:- Login to EquitableHealth.ca
- Select “Documents”
- Toggle between English and French forms
- Click on the document name to download a PDF copy
Over-age dependents losing coverage?*
Some of your clients’ plan members may have dependents who are reaching the maximum age for eligibility under their group benefits plan.
If they are attending school full-time or are disabled, they may be eligible for continued coverage. Plan members with over-age dependents can simply complete the Application for Coverage of Dependent Child Over Age 21 (Form #441) and submit it through our online document submission tool. They can access the tool by logging into their Group Benefits account at www.equitablehealth.ca and clicking My Resources.
If they are not attending school full-time or disabled, they will no longer be covered under the plan. However, they may be eligible for Coverage2go®. It allows individuals who are losing their group coverage to purchase personal month-to-month health and dental coverage that is affordable, reliable and works like their previous group benefits plan. They can choose the level of coverage and protection that suits their personal situation.
There are no medical questions – they simply need to apply within 60 days of losing their health coverage under their group benefits plan.*
Help your clients’ plan members and their dependents who are losing coverage by letting them know about Coverage2go. They can visit our website to learn more about Coverage2go and to get a quote.
*Quebec residents are not eligible for Coverage2go - [pdf] The Approach to Suitable Sales - Reference
- Additions and Increases
- [pdf] Personalized Ads - What does your retirement bucket list include?
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WFG KYC and Trade Ticket documents are now part of EZcomplete
Equitable Life® wants to help you get on with your day. Effective June 11, 2022, WFG’s KYC* and Trade Ticket documents will be integrated into the highly rated EZcomplete® online application tool. This means no more completing these documents separately and uploading them to EZcomplete.
By integrating the KYC and Trade Ticket with EZcomplete:-
these documents will automatically populate with information collected in the EZcomplete process,
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necessary signatures will be captured, and
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these documents will be sent to WFG’s back office on your behalf.
Once the application has been submitted, signed documents will be available for advisors, clients, and joint clients to download. It is that easy.
Get on with your day with Equitable Life. Log in to EZcomplete today.
Speak to your Regional Investment Sales Manager to learn more.
* KYCs on corporately owned policies are not currently supported
® denotes a trademark of The Equitable Life Insurance Company of Canada. -
- [pdf] A Retirement Savings Plan is just as relevant now as it was over 60 years ago
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Simplified Alternative ID Process is Now Available
We have updated form 1710 to help you validate your client’s identification when you are not face-to-face, or if your client does not have one of the primary sources of ID.
Form 1710, Verification of Identity for Policyowner, will simplify the ID collection process currently in place. This form will help you with the validation of ID and provide you with space to record the details. New with this form is the ability to validate your client’s ID over a video call by documenting the details of the ID, and then having your client hold up the document and read the information for you to validate. You no longer need to obtain and submit copies of the identification documents to Equitable.
If your client requests the use of the Alternate ID process for a paper application, you can use this form to satisfy your identification validation requirements.
For more information, please see Section 2 of Form 1710 entitled “Alternate ID”. As well, you can refer to the “how to complete form 1710” Guide for further details.
Additional resources:
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Important information regarding use of the form 350 Application for Life and/or Critical Illness Ins
As of February 12, 2022 the new version of the form 350 (2022/02/12) was available on EquiNet® (Individual Insurance>Forms), and can be ordered from our Supply department using form 1390 Supply Order Form (Life and Health)
To apply for the new 10 pay premium option on Equimax Estate Builder, or the new EquiLiving plans or riders, the new version of the form 350 (2022/02/12) Application for Life and/or Critical Illness Insurance must be used. The new version of the 350 will include the option to select the new features.
We will not accept the 350 (2021/04/02) version of the application with a hand-written note indicating the new 10 pay premium option, or the new EquiLiving plans or riders.
After March 31, 2022, we will no longer accept the 2021/04/02 or earlier version of the 350 application for any life or critical illness products. -
On June 26, 2021 make room for more EDO room
Effective June 26, 2021, a term rider added to an Equimax Estate Builder® or Equimax Wealth Accumulator® policy may allow for an increase to the maximum Excelerator Deposit Option (EDO) payment limit.
Your clients who have a temporary insurance need and add a term rider to their Equimax plan may be able to take advantage of the additional exempt room and higher EDO payment limits to build the policy values. Make Equimax® your first choice for your clients’ whole life insurance needs.
Want more information?
Learn more about the changes and transition rules.
Contact your Regional Sales Manager for more information on these changes and other sales ideas.