Site Search

362 results for where to check completed case

1. 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 Arthritis
   		Erelzi	Ankylosing Spondylitis Psoriatic Arthritis Rheumatoid Arthritis
   infliximab	Remicade	Inflectra Renflexis	Ankylosing Spondylitis Plaque Psoriasis Psoriatic Arthritis Rheumatoid Arthritis Crohn’s Disease Ulcerative Colitis
   insulin 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 Renflexis	Crohn’s Disease Ulcerative Colitis

   We 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.

2. 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.

3. 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 members

   During 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 initiative

   As 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 Tax

   The 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 limits

   In 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 healthcare

   With 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 coverage

   We 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.

4. 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.
5. [pdf] Cloud DX FAQ
6. [pdf] FHSA to RSP/RIF Conversion
7. [pdf] WorldCare Medical Second Opinion Service
8. [pdf] Coverage2go
9. [pdf] New Forms to Comply with AML & CRS Changes