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  1. Compliance Resources
  2. Product at a glance
  3. [pdf] Pivotal Select Application - Registered/Non-Registered
  4. Group Benefits - Premium relief for Dental and Extended Health Care benefits

    We know this is a difficult time for Canadian employers and that many of your clients are facing financial hardship as a result of the COVID-19 pandemic. We continue to look for ways to help employers manage while still supporting their employees.

    With many health practitioners closing their offices due to the pandemic restrictions, plan member use of dental benefits and some health benefits has declined.

    So, we are pleased to announce that we are offering premium relief for all Traditional and myFlex insured non-refund customers for Health and Dental benefits, as follows:

    • A 50% reduction on Dental premiums; and
    • A 20% reduction on vision and extended healthcare rates (excluding prescription drugs), which equates to an 8% reduction on Health premiums. 

    These reductions are retroactive to April 1, 2020 and will appear as a credit against the next available billing. We will assess the situation monthly and expect to continue with monthly refunds for as long as the current crisis period continues.

    We expect that claims experience and premiums will return to normal once the current pandemic restrictions are lifted.

    In the meantime, plan members will continue to have full access to their benefits coverage throughout the pandemic. In many cases, dental offices remain open for emergency services, and a variety of healthcare providers are available virtually.

    Commissions

    We know the pandemic has put financial strain on your business as well, so we will continue to pay full compensation. Although your overall commission will be unaffected by these premium reduction adjustments, you may see a temporary reduction in your commission payments if you are on a pay-as-earned basis while we put through mass changes. If so, we will then make an additional top-up payment to cover that shortfall as soon as we are able.

    Communication

    We will be communicating this premium relief program to your clients April 21st at 8:00am EST.

    A PDF of the communication is also available here.

    Questions?

    If you have any questions, please contact your Group Account Executive or myFlex Sales Manager. In the meantime, we have provided some Questions and Answers below.

    Will the premium reduction on Health and Dental benefits have an impact on the renewals that were deferred?
     
    No. Renewals will proceed as normal, with rate adjustments based only on months where full premium was paid. For most clients, we anticipate “normal” rate adjustments at renewal compared to rates paid prior to refunds taking effect.
     
    Does this adjustment apply equally to clients who have had their renewal deferred?
     
    Yes, these adjustments apply to all Traditional and myFlex insured, non-refund customers for Health and Dental benefits.
     
    How does this affect clients who have terminated or amended a plan?
     
    If a benefit is in-force during the month of April, the adjustment will be credited to the next available billing. For clients who have temporarily terminated all benefits, this will be applied against the first bill once benefits have been reinstated. No cash refunds will be paid.
     
    Will you recover any of the adjustment at a future point in time?
     
    No, we will not recover this adjustment.
     
    Instead of this premium reduction adjustment, can a client cancel or adjust some of the benefits on their plan?
     
    Yes, you and your clients always have the option of changing the coverage on a plan, such as reducing or removing a benefit to help control costs. Please speak to your Group Account Executive or myFlex Sales Manager about the options available.
     
    Are TPAs and self-administered groups eligible for the premium reduction?
     
    Yes. TPAs and self-administered groups are eligible for the premium reduction. However, timing for the credit will be dependent on the billing practices of the TPA or self-administered group. We will apply these credits as soon as we are able.

  5. [pdf] Borrowing money to save money
  6. [pdf] Your Guide to EquiLiving (Client Guide)
  7. [pdf] Benefits of segregated funds in a TFSA
  8. [pdf] Dialogue Virtual Healthcare Overview
  9. 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):

  10. April 2024 eNews

    In this issue:

    • Competitive – and easy – benefits plans for your small business clients
    • Simplifying benefits enrolment for your clients*
    • NEW time-off tracking tool from HRdownloads*
    • Focus on benefits fraud: Protecting your clients’ plans from abuse*
    *Indicates content that will be shared with your clients who receive these benefits.
     

    Competitive – and easy – benefits plans for your small business clients

    Supporting your small business clients can be a challenge. It’s tough to find a competitively-priced benefits plan with the features they want. Small business owners may also need more of your time – especially if this is their first benefits plan.
     
    That’s why we created Equitable EZBenefits™, a benefits solution designed with the needs of small businesses in mind. With a range of plan design options and valuable embedded services for plan sponsors and plan members, EZBenefits is available for groups with 2 to 25 employees. And to make things simpler for you, we’ve created an Advisor Concierge Service exclusively for EZBenefits. Whether you have a question about submitting a quote request for a new client or an issue with an in-force client, our Concierge Service is your go-to resource for EZBenefits support.  

    Don’t have any EZBenefits clients yet?

    To learn more about EZBenefits, watch our video to learn more or view our brochure.

    Simplifying benefits enrolment for your clients*

    Navigating the benefits enrolment period can be overwhelming – for you, your clients and their employees. It’s difficult to ensure all plan members complete the necessary paperwork before the enrolment deadline. 

    That’s why we offer our secure Online Plan Member Enrolment tool at no extra cost to plan sponsors. The tool simplifies the onboarding process for your clients and their plan members by eliminating the need for paper enrolment forms.
     
    It also makes enrolment faster and easier for your clients by:

    • Reducing errors and rework that can occur due to spelling mistakes or missing information on paper forms; and
    • Sending automatic enrolment reminders to plan members, resulting in fewer late applicants. 
    Our user-friendly interface allows plan members to:
    • Enrol in their benefits plan in just minutes from their computer or mobile device;
    • Easily enter all their enrolment information, including dependent details, banking information for direct deposit of claim payments and details for coordination of benefits; and
    • Designate their beneficiary electronically. 

    Ready to share our Online Plan Enrolment Tool with your clients? Get them started with these helpful resources:

    To learn more about how Online Plan Member Enrolment can simplify benefits enrolment for your clients, contact your Group Account Executive or myFlex Account Executive.

    NEW time-off tracking tool from HRdownloads*

    Through our partnership with HRdownloads®, EZBenefits clients now have complimentary access to Timetastic —a time-off tracking tool that can make it easier to manage employee vacation time, sick days and more.
     
    Timetastic integrates seamlessly with HRdownloads and includes a mobile app to help manage time-off requests from any mobile device.
     
    To see Timetastic in action, check out this demo.
     
    EZBenefits also includes other helpful resources and tools from HRdownloads that can make daily human resources tasks easier, including:
    • A robust, award-winning HR management platform (HRIS);
    • HR documents, templates, compliance resources and articles; and
    • A live HR advice helpline. 
    All of our other Equitable group benefits clients can get a 10% discount on HRdownloads services. Visit the link below or contact your Account Executive for more information.

    Learn more about accessing HRdownloads.

    Focus on benefits fraud: protecting your clients’ plans from abuse*

    According to the Canadian Life and Health Insurance Association (CLHIA), benefits fraud costs insurers and plan sponsors millions of dollars each year, which can lead to increased premium costs.
     

    Resources for your clients

    Both plan administrators and plan members play a role in preventing benefits abuse. So, we’ve compiled some resources you can share with your clients to help them understand what benefits fraud is and how to prevent it: Encourage your clients to educate their plan members about the potential consequences of benefits fraud, including losing their benefits, losing their job and even jail time. 

    How we’re fighting benefits fraud

    Our Investigative Claims Unit (ICU) works to detect and eliminate benefits fraud. We use a variety of investigative techniques, including CLHIA-led industry tools to detect and eliminate benefits fraud: 
    • Joint Provider Fraud Investigation Program: A robust program that allows insurers to collaborate on fraud investigations that affect multiple insurers;
    • Data Pooling Program: An initiative that pools data between insurers and uses advanced artificial intelligence to further identify and reduce benefits fraud; and
    • Provider Alert Registry: A registry that allows insurers to view the results of other insurers’ anti-fraud investigations into specific practitioners. 
    To learn more about benefits fraud and Equitable’s commitment to protecting our benefits plans, please contact your Group Account Executive or myFlex Account Executive.