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1. COVID-19 Group Benefits Updates
2. [pdf] S&R Quick Reference Guide
3. [pdf] Shareholder Borrowing Checklist
4. 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):

   

5. January 2023 eNews

   Responding to Saskatchewan’s biosimilar switch initiative*

   We are changing coverage for some biologic drugs in Saskatchewan 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. 
   
   Saskatchewan’s provincial biosimilar initiative
   Announced in October 2022, the Saskatchewan Biosimilars Initiative ends coverage of ten biologic drugs beginning on April 30, 2023.
   
   Patients in the province who are using these drugs will be required to switch to biosimilar versions of these drugs by April 30, 2023, in order to maintain their Saskatchewan Drug Plan 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 Saskatchewan for most biologic drugs included in the provincial initiative.
   
   Beginning April 30, 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.  
   
   Communicating this change to plan members
   We will inform any affected plan members in early February 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 Saskatchewan includes more biologic drugs in its biosimilar initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.
    

   Ontario announces 2023 biosimilar switch program*

   The government of Ontario recently announced the launch of a biosimilar initiative to switch patients from eight originator biologic drugs to biosimilar versions of the drugs.
   
   Patients in Ontario using affected originator biologic drugs will have until December 29, 2023 to switch to a biosimilar version of their medications in order to maintain coverage under the province’s public drug plans.
   
   We are actively monitoring and investigating the impact of this new policy on private drug plans in Ontario. We plan to implement changes to coverage of biologic drugs in the province in 2023 to help prevent this change from resulting in additional costs for our clients’ drug plans. We will provide more details in the coming months.
   
   If you have any questions, please contact your Group Account Executive or myFlex Sales Manager.
    

   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 2023.*** 

   Dental fee guide increases over 2022***

   
   
   ***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.
    

   Equitable Life ranks high with Canadian group advisors*

   Equitable Life ranked second nationally and first in Ontario among major insurers in a recent survey of Canadian group benefits advisors.
    
   NMG Consulting, a leading global consulting firm, conducted in-depth interviews with 130 leading group consultants, brokers and third-party administrators across the country between May and August 2022 for its annual Canadian Group Benefits Study. Based on these interviews, NMG ranked group insurers in six categories, ranging from operational management to technology.
   
   Nationally, Equitable Life ranked either first or second in four of the six main categories:
   
   Advisors in Ontario, in particular, scored Equitable Life very favourably. We ranked #1 overall in the province, finishing first in four of the six overall categories, including: Relationship Management, Operational Management, Underwriting and Claims Management and Technology.
    
   “The fact that advisors regard us so highly in so many categories is a testament to our mutual status and our ability to focus exclusively on our clients and advisors,” said Marc Avaria, Senior Vice President of Group. “We are truly working together to build strong, enduring and aligned partnerships.”
    
   “While we are happy with these results, we won’t rest on our laurels,” added Avaria. “We will continue to dedicate ourselves to providing our clients and advisors with a better benefits experience.”
   
   Here are more of the highlights from this year’s results:
    
   Nationally, we ranked first in all 10 subcategories in Operational Management, including:
   • Overall service to intermediaries,
   • Overall service to plan sponsors,
   • New quote process,
   • Plan implementation,
   • Renewal process,
   • Information shared at renewal,
   • Accuracy and timeliness of reporting and billing,
   • Administration quality and responsiveness,
   • Taking ownership and
   • Management information quality and availability.
   We also ranked first in Relationship Management, getting top marks in 7 of 10 subcategories, including:
   • Company relationship management,
   • Ease of doing business,
   • Account executive capability,
   • Market knowledge,
   • Visit/call quality,
   • Effective coordination and
   • Advice.
   We ranked second in Underwriting and Claims Management, finishing in the top three for all subcategories, including:
   • Fairness and timeliness of disability claims (1^st)
   • Fairness and timeliness of health claims (2^nd)
   • Fraud management (2^nd)
   • Competitiveness of pooling charges (2^nd)
   • Group underwriting flexibility (3^rd)
   • Health and dental TLR competitiveness (3^rd)
   And we ranked second in Technology, finishing in the top three for:
   • Overall technology – Intermediary (2^nd)
   • Member experience (2^nd)
   * Indicates content that will be shared with your clients.
    
6. 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.
7. Enhanced flexibility and features make Equimax whole life a great choice for your clients

   WHAT’S NEW ON MARCH 23, 2020?

    
   The following features are available on Equimax Estate Builder^® and Equimax Wealth Accumulator^® plans!   
   
   60 months of EDO payment flexibility¹ that fits your clients’ situation

   • Clients can start EDO payments¹ up to 60 months from the date the application was signed, or resume up to 60 months from the last EDO payment made, without additional evidence of insurability.
   • Applies to Equimax² policies with an effective date of March 23, 2020 or later. 
   
   
   
   
   EDO is available on cases rated 300% or less³ for new and existing clients
   • For existing clients, if approved, the EDO contract provisions that apply will be based on the effective date of the insurance policy, not the date the EDO was added.
   • Applies to Equimax² policies issued under the 2017 tax rules.
   
   
   
   Built-in Disability Benefit Disbursement provides access to cash value in the event of a disability
   • The Disability Benefit Disbursement may provide a tax-free, lump sum payment of up to 100% of the policy’s cash value if the insured becomes disabled.⁴
   • Will be included on Equimax² policies issued under the 2017 tax rules.⁵

   
   
    

   Want more information?

   More information is available on EquiNet^® on the Whole Life Insurance Product page under the Resources tab. 
   
   Ask your Equitable Life^® Regional Sales Manager about Equimax today.

   COVID-19 & social distancing: Strategy for insurance applications   Using our EZcomplete® online application allows you to keep your distance … while keeping your business moving forward.   Learn more

    

   
   ¹ This applies only to policies with an effective date of March 23, 2020 or later. The amount of the EDO payment allowed may be limited to the maximum EDO payment made in previous years depending on the policy year. For approved EDO amounts exceeding $150,000 annually ($12,500 monthly), clients have up to 12 months from the date the EDO application was signed or the date of the last EDO payment to make an EDO payment before a contribution cap may apply. See Admin Guide for full details.  ² Applies to Equimax Estate Builder and Wealth Accumulator; all ages; life pay and 20 pay; single and joint lives. ³ Not available if the policy has a flat extra rating. ⁴ See sample policy contract for full details, including the qualifications for the disbursement. Policy cash value and death benefit will decrease. Tax laws are subject to change. The payment of the disability benefit disbursement may affect the adjusted cost basis (ACB) of the policy as it is considered payment of a capital benefit. Changes in ACB can affect the future taxation of the policy.  ⁵Subject to our administrative rules and guidelines in effect at the time of the disbursement

8. About
9. [pdf] What's New July 6 2017