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1. 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.

2. 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
   Advantages for plan sponsors include:
   • 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
   For more information about how Equitable Life benefits plans can support the needs of those seeking gender affirmation surgery view our resources: 
   • Guide to Gender Affirmation Procedures and Therapies
   • Gender Affirmation Coverage Overview
   You can also contact your Group Account Executive for more information. If you have clients with myFlex plans who are interested in Gender Affirmation Coverage, please contact your myFlex Sales Manager to determine eligibility. 
    

   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
   By surveying plan members and plan sponsor representatives across Canada each year, Benefits Canada works with its Advisory Board to provide timely insights on the employee benefits issues that are most important to Canadians. This year, our Group Vice-President of Western Sales, Meghan Vallis, has provided her expertise as an Advisory Board member.
   
   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
   If your clients have Plan Administrator reporting access on EquitableHealth.ca, they can determine which plan members have a zero allocation by running the HCSA Totals by Plan Member report online by doing the following:
   • 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
   To provide us with the amounts to be updated, please have your client contact our Group Benefits Administration Team at GroupBenefitsAdmin@equitable.ca. 
   
    
3. [pdf] Custom Quote - DIA/GIA
4. 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

5. [pdf] Third Party Form
6. Financial planning concepts & tools
7. [pdf] Create A Household - Equitable GIF
8. Forms
9. [pdf] Invest with Equitable