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February 2020 Advisor eNews
In this issue:
Provincial biosimilar update
Legislative changes for Alberta’s Coverage for Seniors program
Coming soon: enhancements to Equitable EZClaim® Online
Provincial biosimilar update
Alberta Biosimilar Initiative
On December 12, 2019, the Alberta government introduced the launch of the Alberta Biosimilar Initiative. This program will require patients using several originator biologic drugs to switch to a biosimilar, and patients using a non-biologic complex drug (NBCD) to switch to its subsequent entry version before July 1, 2020 in order to maintain coverage.
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” drug. Biosimilars 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.
Alberta Health will initially cover both the originator and biosimilar or subsequent entry version of a NBCD drug as patients start the switching process.
The following table outlines the affected originator drugs, their biosimilars or subsequent entry, and the conditions affected by the program.
Biosimilar Drug Originator Biosimilar/Subsequent Entry Indications Affected etanercept Enbrel Brenzys Ankylosing Spondylitis
Rheumatoid ArthritisErelzi Ankylosing Spondylitis
Psoriatic Arthritis
Rheumatoid Arthritisinfliximab Remicade Inflectra
RenflexisAnkylosing Spondylitis
Plaque Psoriasis
Psoriatic Arthritis
Rheumatoid Arthritis
Crohn’s Disease
Ulcerative Colitisinsulin glargine Lantus Basaglar Diabetes (Type 1 and 2) Filgrastim Neupogen Grastofil Neutropenia pegfilgrastim Neulasta Lapelga Neutropenia glatiramer* Copaxone Glatect Multiple Sclerosis *Glatiramer is a non-biologic complex drug where the originator is Copaxone and the subsequent entry is Glatect.
Equitable Life is actively investigating the benefit, risk and appropriate plan changes associated with this new policy on private drug plans and will keep you informed.
For more information about the Alberta Biosimilars Initiative, consult the Alberta government website.
British Columbia
In 2019, BC Pharmacare introduced a Biosimilars Policy that impacted coverage of three biologic drugs – Remicade, Enbrel and Lantus. As of November 25, 2019, these drugs were no longer eligible in BC for most conditions for which lower cost biosimilar versions are available. Patients in the province with these conditions were required to switch to biosimilar versions of these drugs in order to maintain their coverage.
The second phase of the BC Biosimilar Policy takes effect March 6, 2020 when Remicade will be delisted for Crohn’s Disease and Ulcerative Colitis. Patients in the province with these conditions will be required to switch to Inflectra or Renflexis in order to maintain their coverage.
Biosimilar Drug Originator Biosimilar Indications Affected infliximab Remicade Inflectra
RenflexisCrohn’s Disease
Ulcerative ColitisWe have communicated with the affected plan members, informing them of the need to switch medications. If plan members have any questions or concerns, our Customer Care team is here to help and support them through the transition.
If you have any questions about this policy, please contact your Group Account Executive or myFlex Sales Manager.
Ontario
In November 2019 Ontario Minister of Health Christine Elliot indicated that the government was planning to launch consultations to explore solutions in managing biologics.
Equitable Life will continue to monitor these developments and keep you informed of any impact on private drug plans.
Legislative changes for Alberta’s Coverage for Seniors program
The government of Alberta has announced that as of March 1, 2020, seniors’ family members (such as spouses and dependents) who are younger than 65 will no longer be covered by the provincial Coverage for Seniors program. Albertans 65 years of age and older will continue to be covered under the provincial plan.
Equitable Life plan members and their dependents will continue to be covered under the parameters of their group benefits plan.
For more information, please see the Alberta Seniors Health Benefits website.
Coming soon: enhancements to Equitable EZClaim® Online
Faster vision claims processing and payment
Equitable Life will soon provide real-time processing of vision claims submitted via EZClaim Online.
This means plan members will be able to find out the status of their vision claim almost instantaneously. And, for approved claims, they will receive payment even sooner – often in as little as 24 hours.
In order to allow for instantaneous processing and faster payment, plan members will be prompted to enter some additional information including the practitioner’s name, the date of the expense, the type of expense and amount of the expense when submitting their claims for these services.
Equitable Life plan members can submit all vision claims via EZClaim, including coordination of benefits and Health Care Spending Account claims.
This enhancement will be coming to our EZClaim Mobile app in the coming months.
New printable claims extract
As part of our ongoing efforts to improve customer experience for plan members, we will also offer a claims extract in a printable format within the plan member site. Plan members will be able to select a date range and claimant, then generate and download a detailed list of health and dental claims. This is a helpful way to keep track of claims, especially when reviewing them in preparation for income tax filing.
Once these enhancements are live you will be notified in an eNews, and an announcement will be posted on the plan member section of EquitableHealth.ca.
Elimination of Out-of-Country Travellers Program in Ontario
Effective January 1, 2020, the Ontario government eliminated OHIP coverage for emergency services for Ontarians travelling outside of Canada.
Previously, the Out-of-Country Travelers Program provided some reimbursement for services required to treat conditions that are acute, unexpected, arose outside Canada and require immediate treatment. The program covered between $200 and $400 per day for inpatient services and $50 per day for outpatient and doctor services.
For groups who have out-of-country coverage from Allianz, this change will not impact the cost to your plan members, or the process plan members follow in the event of an emergency while travelling.
Plan members should still call Allianz in the event of an out of country emergency. Allianz will deal with their claim as usual and will now pay for the portion of the claim previously paid by OHIP. Plan members will not have any additional out-of-pocket costs.
We will be sharing this information with plan members as a news item on our plan member website, equitablehealth.ca.
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Equitable Life Group Benefits Bulletin – May 2020
In this issue:
- Digital options for your clients and their plan members*
- Alberta delaying biosimilar initiative*
- Yukon increasing insurance premium tax*
- Manitoba and New Brunswick relaxing drug limits*
- Free guide to accessing virtual healthcare*
- Homeweb for plan members who are losing coverage*
*Indicates content that will be shared with your clients
Easy and convenient digital resources for your clients and their plan membersDuring this time of physical distancing, people are looking for ways to interact with their providers virtually. We have several convenient digital tools available to make it easier for your clients and their plan members.
For plan administrators:
Plan administrator portal (EquitableHealth.ca)Our secure portal allows plan administrators to easily manage their plan anytime and anywhere. Instead of printing and mailing forms, they can make real-time updates at their convenience. The site also makes it easy to:
- View or upload forms and other important documents;
- Retrieve billing information;
- Estimate monthly premium costs; and
- View announcements, tips and reminders.
Plan administrators can visit www.equitablehealth.ca to activate their account.
Digital Welcome Kits
Instead of paper kits that can easily get lost or quickly become outdated, plan members receive personalized welcome kits via an interactive email, including instructions on how to:
- Activate their online group benefits account;
- Download their digital benefits card;
- Submit claims from their computer or mobile device;
- Review their coverage details; and
- Explore health and wellness resources.
Easy automated payments
Automated payments are a convenient way to avoid missed payments, suspended claims and disruption. Plan administrators simply complete the pre-authorized debit form and send to GroupCollections@equitable.ca. Or contact Group Collections about online banking and electronic funds transfer (EFT).
We can help
For assistance, plan administrators can contact their Client Relationship Specialist or our Web Services team at 1.800.265.4556 ext. 283 or groupbenefitsadmin@equitable.ca.
For plan members:
Plan member portal (EquitableHealth.ca)By logging into EquitableHealth.ca, plan members have secure 24/7 access to their personalized Group Benefits account. They can:
- View and submit claims;
- Review their coverage details; and
- Access health and wellness resources.
Electronic claims payment and notifications
Once plan members have activated their Group Benefits account on EquitableHealth.ca, they can easily set up receiving their claim payments via direct deposit, and their claim notifications via email.
EZClaim Mobile App
Submitting claims is fast, easy and secure with the Equitable EZClaim® mobile app for iOS and Android devices. Plan members can view and submit health and dental claims and review their coverage details.
Digital Benefits Cards
Instead of digging through their wallets, plan members can download a digital version of their benefits card to their mobile device.
We can help
We’ve created a video guide to help plan members access and use their digital resources. For further assistance, plan members can contact our Web Services team at 1.800.265.4556 ext. 283 or groupbenefitsadmin@equitable.ca.
Alberta government delaying biosimilar initiativeAs we announced in the February 2020 issue of eNews, the Alberta Biosimilar Initiative will require patients using several originator biologic drugs to switch to a biosimilar in order to maintain coverage through their Alberta government sponsored drug plan.
Due to the increased demands the COVID-19 pandemic is placing on healthcare providers, the Alberta government has postponed the switching requirement. Affected patients will now have until January 15, 2021 to switch to the biosimilar version of their drug in order to maintain provincial coverage.
We continue to investigate appropriate options to help ensure this provincial change does not unreasonably impact Equitable Life groups and patients and will keep you informed.
For more information about the Alberta Biosimilars Initiative, consult the Alberta government website.
Yukon increasing Insurance Premium TaxThe Yukon Government has announced that it plans to increase its Insurance Premium Tax rates effective January 1, 2021. The premium tax rates for group life and accident and sickness insurance are expected to increase from 2% to 4%. The new tax rates will be applied to premiums paid on or after January 1, 2021.
Manitoba and New Brunswick relaxing drug limitsIn order to protect the drug supply during the COVID-19 crisis, residents of most provinces were temporarily limited to receiving a 30-day supply of drugs when filling a prescription. Normally, doctors prescribe a 90-day supply for most maintenance-type drugs.
The Government of Manitoba and the Government of New Brunswick are now relaxing this 30-day limit for prescription drugs where shortages do not exist. They will address potential shortages of specific drugs if necessary.
As the situation continues to evolve, there may continue to be changes to provincial legislation and prescription limits. Plan members should speak to their pharmacist for the most up to date information.
Free guide to accessing virtual healthcareWith many health clinics closed and the healthcare system under strain, people are looking to access a doctor and other health providers virtually.
As we announced previously, we’ve made it easier for plan members to find the information they need using our Guide to Accessing Virtual Healthcare. This online resource provides information about and links to a range of virtual health services they need to take care of their health and the health of their family during these challenging times.
The Guide also indicates which services are covered by public health plan, so there’s no cost to the patient to access them if they provide their valid provincial health card.
We will continue to update the Guide as more virtual healthcare providers and services become available.The Guide is available on both EquitableHealth.ca and Equitable.ca.
Homeweb for plan members who are losing coverageWe know these are difficult times for Canadian employers and their employees. As businesses temporarily suspend operations, some employers have had to make the difficult decision to temporarily lay off employees or put their benefits coverage on hold.
That’s why we were pleased to announce that Homewood Health® and Equitable Life will extend access to Homeweb, a personalized online mental health and wellness portal, for up to 120 days for plan members who have temporarily lost their benefits coverage due to COVID-19.
Employees and their family members will continue to have access to the Homeweb website and mobile app, including:
- iVolve, online self-directed Cognitive Behavioural Therapy;
- Resources to support themselves and their family members through the COVID-19 pandemic;
- An interactive online Health Risk Assessment; and
- An online library of tools, assessments and e-courses.
This will allow businesses undergoing financial hardship to provide some support to employees who are temporarily without benefits coverage.
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