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Equitable Life Group Benefits Bulletin - November 2022
The importance of timely plan member eligibility updates*
Effective Dec. 1, 2022, we are implementing a revised process for managing plan member and dependent health and dental claims that have been incurred and paid after coverage has been terminated. This new process is consistent with industry practices.
If health or dental claims have been incurred and paid after a plan member’s termination date but before we received notice of the termination, we will align the plan member’s or dependent’s termination date with the service date of the last paid claim, retaining premiums up until that date.
If no claims have been incurred and paid after the termination date, Equitable Life will process the termination as requested and refund any excess premium, subject to a maximum premium refund credit of three months.
Currently, we process the termination as requested and attempt to recover any claim overpayments directly from the plan member. We then refund any excess premiums that have been paid, subject to the maximum refund credit amount.
To avoid claims being incurred and paid after a plan member’s termination date, it is important for your clients to update plan member and dependent eligibility dates on or before the effective date of the change.
If you have any questions about the process your clients should follow for updating plan member eligibility, please contact your Group Account Executive or myFlex Sales Manager.QuickAssess®: Absence and accommodation request review services*
It can be difficult to navigate chronic or complex cases of absenteeism or accommodation requests. That’s where QuickAssess® can help.
QuickAssess is an optional, fee-per-use service that can provide your clients with an unbiased, timely assessment of complex plan member absences and workplace accommodation requests. Our disability experts can provide recommendations to help your clients manage:- Workplace absences
- Chronic or patterned absenteeism
- Requests to modify workplaces or duties
- Return-to-work coordination
- Employee Insurance sick leaves
For more information on using QuickAssess, including eligibility requirements, please contact your Group Account Executive or myFlex Sales Manager.
**Within two business days of receiving a completed QuickAssess Absence and Accommodation Review Referral Form and all required information. For more complex referrals, more time will be required.Finding a health care provider with TELUS eClaims direct billing*
By visiting TELUS’s Find a Provider page, your clients’ plan members can now easily search for paramedical and vision providers who are registered on the TELUS Health eClaims network and who can submit claims directly to us on behalf of their patients. Searches can be filtered by postal code to help plan members find the most convenient provider options.
As our direct billing provider for pharmacy, vision and paramedical claims, TELUS Health has an extensive network of 70,000 health care providers that provide direct billing to streamline the claims process.
Please note, plan members should always check Equitable Life’s list of de-listed providers before selecting a health care provider. The list is available for your clients and their plan members on EquitableHealth.ca, and is updated regularly.
For more information about TELUS eClaims, please contact your Group Account Executive or myFlex Sales Manager.First phase of the Canada Dental Benefit proposed for Dec. 1, 2022*
The federal government’s new Canada Dental Benefit is proposed to take effect on Dec. 1, 2022, subject to Parliamentary approval. The program will cover eligible expenses retroactive to Oct. 1, 2022, and this first phase would apply to Canadians under 12 years of age.
If implemented, the Canada Dental Benefit will provide dental care to Canadian families with under $90,000 adjusted net income annually. By 2025, the federal government expects to extend the benefit to children under 18, senior citizens and Canadians with disabilities.
Parents or guardians will be required to apply for this coverage through the Canada Revenue Agency (CRA) and must not have private dental coverage for the child(ren).
This new program will have no impact on your clients’ dental coverage and no action is required on their part.
* Indicates content that will be shared with your clients.
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April 2023 eNews
Vision care discounts from Bailey Nelson for Equitable Life plan members*
We are pleased to announce we are partnering with Bailey Nelson to provide Equitable Life plan members with discounts on prescription and non-prescription eyewear. Bailey Nelson is a leading provider of prescription glasses, contact lenses and sunglasses with locations across Canada, as well as an online store.
All Equitable Life plan members will have access to the following discounts from Bailey Nelson:
*Includes anti-reflection and anti-scratch treatment. Glasses offers are based on 2 pairs of single vision or 1 pair of premium progressive lenses. Lens add-ons, such as high-index lenses and prescription tinted lens tints may involve additional costs.
**Non-prescription glasses only. Cannot be combined with 2 for $200 discount.
Plan members can provide their Equitable Life discount code in-store or at online checkout. Your clients may wish to distribute this convenient flyer with an overview of the available discounts to their plan members.
Plan members can bring their prescription to a Bailey Nelson location or provide it online to order glasses and contact lenses. Bailey Nelson also provides eye exams in-store for $99.
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager.
Equitable Life helps tackle benefits fraud through Joint Provider Fraud Investigation (JPFI) initiative*
Protecting your clients’ plans is important to us. That’s why Equitable Life is working with other Canadian life and health insurers to conduct joint investigations into health service providers that are suspected of fraudulent activities through the Canadian Life and Health Insurance Association’s (CLHIA’s) Joint Provider Fraud Investigation (JPFI) initiative. This collaborative initiative between major Canadian life and health insurers through the CLHIA is a major step toward reducing benefits fraud in the life and health benefits insurance industry.How the JPFI works
The JPFI builds on the 2022 launch of a CLHIA-supported industry program. The program uses advanced artificial intelligence to help identify fraudulent activity across an industry pool of anonymized claims data. Joint investigations will examine suspicious patterns across this data.
Through this project, Equitable Life can initiate a request to begin a joint fraud investigation when we:- See suspected provider fraud in our own data or the pooled data, or
- Receive a substantiated tip about potential provider fraud
How Equitable Life protects your clients’ benefits plans from fraud
Benefits fraud is a crime that affects insurers, employers and employees and puts the sustainability of workplace benefits at risk. CLHIA estimates that employers and insurers lose millions each year to benefits fraud and abuse.
Our Investigative Claims Unit (ICU) consists of security and fraud experts who use data analytics and artificial intelligence to proactively identify and investigate suspicious billing patterns or claims activity to open investigations. We de-list healthcare providers who are engaged in questionable or fraudulent practices, pursue the recovery of improperly obtained funds, and report practitioners to regulatory bodies and law enforcement where appropriate.
Learn more about benefits fraud, or contact your Group Account Executive or myFlex Sales Manager for more information.Second phase of TELUS eClaims transition*
In June 2022, we switched to TELUS Health eClaims as our digital billing provider to give our plan members a faster and more convenient option for submitting paramedical and vision claims. The switch has allowed our plan members to take advantage of TELUS’s extensive network of over 70,000 paramedical and vision providers.
We’ve now begun the second phase of our TELUS Health eClaims implementation. This phase will focus on improving the experience for paramedical and vision providers. We will begin issuing reconciliation statements for the claims they submit on behalf of their patients. These statements will make it easier for them to use the TELUS Health eClaims portal and provide incentive for even more providers to sign up.
Please encourage your clients to remind their plan members about this convenient option. We have created a helpful one-pager that plan members can bring with them next time they have an appointment with their healthcare provider.
If you have any questions about TELUS Health eClaims, please contact your Group Account Executive or myFlex Sales Manager.
Changes to STD application process for COVID-19 cases*
As the COVID-19 situation evolves, we continue to adjust our disability management practices to ensure ongoing support and a fair experience for all our plan members.
As of May 1, 2023, we will begin managing COVID-19-related short-term disability (STD) claims the same way that we manage disability claims for any other illness or condition. If a plan member is unable to work due to COVID-19 symptoms or a positive COVID-19 test, they must now use the standard STD application, including the Attending Physician Statement portion.
Once we receive the claim, we will adjudicate it according to our standard process.
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager.
* Indicates content that will be shared with your clients.
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Paramedicals are Re-opening Shortly
We are pleased to announce that face-to-face insurance testing paramedical services, including the collection of vitals & fluids, are resuming shortly. Our service providers, Dynacare and ExamOne, have been monitoring the public health standards and have established standards they will operate under to protect the health of both the applicant and health professionals.
Our commitment to your client’s safety
It is Equitable Life's commitment that both clients and advisors will be provided clear and thoughtful communication before initiating any testing. Clients should fully understand the potential risks associated with having a paramedical test taken at this time and are always able to choose not to attend the appointment if they do not feel comfortable or safe.
How will paramedical services be conducted?
Dynacare is conducting appointments at fixed site facilities where clients will travel to the health professional for their appointment. The paramedical questions will be covered by video or telephone to minimize the time spent in the fixed site facility. For more information, see Dynacare’s COVID-19 client guide that will be provided to the client directly.
ExamOne examiners will travel to the client’s home for their appointment and the entire paramedical will be conducted at that time. Information about ExamOne’s COVID-19 processes and their Preparing for my exam client guide will also be provided to the client directy.
When are paramedical services re-opening?
In person paramedical services for Equitable Life cases will begin opening gradually. We have worked closely with our service providers, the CLHIA & provincial governments and believe it is prudent to begin re-opening services in the provinces that have a lower incidence of COVID-19. We will expand the schedule as the incidence of COVID-19 lowers or is expected to lower in specific regions.
Please note if you had an order in process prior to services shutting down, the provider will be looking to re-open and complete those orders. If requirements are no longer needed given the non-med limit changes, the order will remain closed.
Schedule for re-opening paramedical services:Province Start Date Saskatchewan June 1-Dynacare, June 11-ExamOne New Brunswick June 8-Dynacare, June 11-ExamOne PEI and Newfoundland June 15, Dynacare and ExamOne Manitoba June 15, Dynacare and ExamOne Alberta June 18, Dynacare and ExamOne British Columbia June 22, Dynacare and ExamOne Nova Scotia June 22, Dynacare and ExamOne Ontario* By June 30, Dynacare and ExamOne Quebec * By June 30, Dynacare and ExamOne
Note: Start dates are subject to change based on the progress of COVID-19.
*Ontario & Quebec to re-open regionally (starting with areas with lower incidence of COVID-19). Specifics for Ontario and Quebec will be communicated closer to the implementation dates for these provinces. Further details can be found in this communication. -
This year’s RSP contribution deadline is March 1, 2022
Does your client want to contribute or open a new policy this Retirement Savings Plan (RSP) season? Whether using paper or our recent EZtransact online platform, here are some important things to remember.
Issuing New Policy with EZcomplete®
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All online applications must be digitally signed and submitted and have a date stamp no later than March 1, 2022.
Issuing New Policy using Paper Application-
For contributions to qualify for the first 60 days, all paperwork must be completed and signed by March 1, 2022. Equitable Life must receive all paperwork by March 7, 2022.
Deposits to Existing Policy
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Advisors can setup a one-time or recurring deposit or edit an existing pre-authorized debit already in place using EZtransact. Online deposits must be made and have a date stamp by March 1, 2022, to qualify for a 2021 tax receipt. New to EZtransact? Try our EZtransact Practice Site to see how EZ it is to use.
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Clients can make online deposits to Equitable Life® through their financial institution’s online banking service. Online deposits must be made and have a date stamp by March 1, 2022, to qualify for a 2021 tax receipt.
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Clients can also make a new deposit to an existing policy by cheque. The cheque must be dated and signed by March 1, 2022. Equitable Life must receive the cheque no later than March 7, 2022.
If online banking is being used to fund the policy – either topping up an existing policy or opening a new policy – the online banking transaction must be completed by March 1, 2022, to receive a 2021 tax receipt.
Do not miss your opportunity to have your contributions count for 2021!
Please note that cheques and other paperwork cannot be backdated. They must be completed and signed by March 1, 2022, to qualify for a 2021 tax receipt.
® denotes a trademark of The Equitable Life Insurance Company of Canada.
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Anti-money laundering legislation changes for Savings & Retirement forms and applications
To comply with the Government of Canada’s anti-money laundering legislation and FATCA/CRS changes, Equitable Life® has updated its Savings and Retirement forms and applications. New online forms and applications are available to download from EquiNet®. Paper applications are also available to order from Equitable’s Supply Team. For a complete list of all forms and applications affected by the anti-money laundering legislation, refer to Anti-money Laundering Legislation Requirements Summary.
What should I do if I have existing paper applications?
If you currently have paper applications (Form #1383, #1384, #799, #355) with a version date that is before April 2, 2021, Equitable Life will continue to accept them, with the caveat that additional information may be required from you and your client to comply with anti-money laundering legislation.
How long can I use my existing paper applications with a version date before April 2, 2021?
Paper applications (Form #1383, #1384, #799, #355) with a version date prior to 2021/04/02 (located on the back page and in the bottom right-hand corner of the application) will no longer be accepted after July 1, 2021. If you have applications with a date that is before 2021/04/02, please destroy them and use the fillable/savable PDF on EquiNet. You can also order paper applications from our Supply Team.
Want to be sure you always have the most up-to-date application? Try our EZcomplete® online application platform. EZcomplete makes it easy to process your non face-to-face applications and allows your clients to provide their signature remotely on their own device.
To learn more about the Government of Canada’s anti-money laundering legislation and FATCA/CRS review the following links.
Government of Canada - Guidance on the Common Reporting Standard
Financial Transactions and Reports Analysis Centre of Canada
If you have any other questions, contact your Regional Investment Sales Manager.
® denotes a registered trademark of The Equitable Life Insurance Company of Canada.
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Equitable Life's RSP Contest: Grand prize winners celebrate a future filled with possibilities!
The Savings & Retirement team at Equitable Life recently celebrated the successful conclusion of their recent RSP contest with a special cheque presentation to Equitable Life client, Kavitaben Rathod, and her World Financial Group (WFG) advisor, Kinnari Patel, who were both thrilled to be selected as the grand prize winners.
The Grow Your Future contest ran from January 1 to March 1, 2023, and offered clients and advisors a chance to win big by making RSP contributions. It was a hit with clients like Kavitaben as it provided them with a compelling reason to work with their advisors to build their wealth. Clients who made a deposit into an Equitable Life RSP policy between January 1 and March 1, 2023, had the chance to win the $5,000 grand prize. When Kavitaben won the grand prize, her advisor Kinnari won $1,000 as well.
Alex Lucero, Regional Investment Sales Manager, Greater Toronto Area, met with both Kinnari and Kavitaben to present the cheque and took some photos to commemorate the occasion. The collaborative effort put in by the Equitable Life team was highly appreciated.
Kavitaben expressed her sincere gratitude, sharing how surprised, excited, and delighted she was to be chosen as the grand prize winner. She described the experience as “an amazing feeling and our best day in Canada! It was a really fortunate moment for me”.
Kinnari also expressed her appreciation to Equitable Life, Alex, and the entire WFG team for the proud moment and shared that the experience gave her “motivation and inspiration in her future work duties”.
Equitable Life's commitment to offering products, services, and choices that best suit clients' needs was evident through the contest. Clients saw contest messaging through social media and equitable.ca, while advisors saw it on the EquiNet advisor website, through emails, and MGA and WFG newsletters.Congratulations to everyone who supported the contest and helped make it a success!
Date posted: April 19, 2023
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Supporting plan members affected by the British Columbia and Northwest Territories wildfires
Wildfires across Canada are disrupting the lives of many Canadians. During this difficult time, Equitable Life is providing additional support to help affected clients and plan members.
Prescription refills
Plan members who have been evacuated and/or lost their medication due to the wildfires will be able to make early refills until September 17, 2023, through TELUS Health, our pharmacy benefit manager.
Replacement of medical or dental equipment and appliances
Plan members who need to replace eligible medical or dental equipment or appliances due to the wildfires should first call 1.800.265.4556 to confirm coverage.
Disability or other benefit cheques
Plan members receiving disability benefits or other benefit reimbursements via cheques can visit www.equitable.ca/go/digital for instructions on how to sign up for direct deposit. It just takes a few minutes. Plan members can also call us at 1.800.265.4556 if they need help, a replacement cheque or assistance arranging a different mailing address.
Mental health support
Unpredictable, large-scale natural disasters can cause people to experience intense reactions, putting a lot of pressure on their mental health. Having coping mechanisms to deal with the current crisis can be a huge help. Any Equitable Life plan member who needs mental health support can visit Homeweb.ca/equitable to access online resources or contact Homewood at 1.888.707.2115.
For plan sponsors who have purchased Homewood Health’s Employee and Family Assistance Program (EFAP), their plan members also have access to confidential counselling services. The EFAP provides plan members with 24/7 access to confidential counselling through a national network of mental health professionals. Whether it’s face-to-face, by phone, email, chat or video, plan members will receive the most appropriate, most timely support for the issue they’re dealing with.
Plan Administrator support
We realize that the fires are having a profound impact on regular business operations in B.C. and N.W.T. If you have clients that are unable to carry out day-to-day plan administration, they can call us at 1.800.265.4556. They can also contact their Customer Relationship Specialist for support.
This is a challenging time for advisors, plan sponsors and plan members. We will continue to monitor the situation and provide additional updates as appropriate.Questions?
If you need more information, contact your Group Account Executive or myFlex Sales Manager.
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Announcing Equitable Life's National Biosimilar Program
Beginning March 1, 2024, we are expanding our biosimilar switch program nationally** to protect all our clients and to make our coverage consistent across Canada.
Our national biosimilar initiative will simplify drug plan coverage, replacing our provincial programs with one program across the country.
Why now?
Over the past few years, most provinces have introduced policies to delist some originator biologic drugs. They require most patients to switch to biosimilar versions of those drugs to be eligible for coverage under their public drug plans. Soon, it is expected that all provincial drug plans will cover only biosimilars.
In response, we have implemented biosimilar switch initiatives in BC, Alberta, Saskatchewan, Ontario, Quebec, New Brunswick and Nova Scotia to align with these provincial changes. Our initiatives are designed to protect our clients from additional drug costs that may result from these government policies while providing access to equally safe and effective lower cost biosimilars.
How will this affect clients’ drug plans?
Because we have already introduced biosimilar switch initiatives in most provinces, the impact of this change will be minimal. It will primarily affect plan members in provinces or territories where we haven’t already required the switch to biosimilars, and plan members who are taking biosimilars that were not originally included in the switch initiative for their province.
Regardless of where they live, plan members across Canada 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. Plan members already taking the originator biologic will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable plan. We will support their transition with education, personalized communication, and resources.
Will this change affect clients' rates?
Any cost savings associated with the change will be factored in at renewal.
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.
What is the difference between biologics and biosimilars?
Advance notice
We will be communicating with affected claimants in early December 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 Account Executive.
**Excludes plan members in Quebec who participate in a separate provincial program. -
Digital tools for your clients and their plan members
In this issue:
- Digital tools for your clients and their plan members*
- QDIPC updates terms and conditions for 2024*
Digital tools for your clients and their plan members*
Do your clients know how to use all the available digital tools in their Equitable® benefits plans? With useful features for both plan administrators and their members, it’s even easier for your clients to access their plans online.Tools for plan administrators
- Our online plan member enrolment tool lets groups and administrators add new plan members online without completing paper forms
- The EquitableHealth.ca plan administrator portal makes it easy for plan administrators to manage their plan anytime and anywhere. Helpful features include:
- A premium calculator to calculate monthly costs for plan members
- A simple process for updating plan member information
- Digital welcome kits provide personalized information directly to plan members through email
- Easy, automated payment options help plan administrators avoid missed payments by offering pre-authorized debit or electronic funds transfer
Tools for plan members
- Our plan member portal at EquitableHealth.ca provides secure, 24/7 access to claims history and coverage details. It also lets members submit claims, and includes health and wellness resources
- Electronic notifications and claims payments give plan members claim updates via email and deposit payments directly into their bank account
- The Equitable EZClaim® mobile app lets plan members submit claims quickly and securely on-the-go from their mobile device
- Digital benefits cards give plan members the convenience to access their benefits cards easily from a mobile device
Help with digital benefits tools
We’ve created a brochure and video guide to help plan members use digital tools for a smoother, more convenient benefits experience.
Plan members can contact us at 1.800.265.4556 and select the option for Web Support if they need further assistance.
QDIPC updates terms and conditions for 2024*
Every year, the Quebec Drug Insurance Pooling Corporation (QDIPC) reviews the terms and conditions for the high-cost pooling system in the province.
Based on its latest review, QDIPC is revising its pooling levels and fees for 2024 to reflect trends in the volume of claims submitted to the pool, particularly catastrophic claims. These updates take effect January 1, 2024. You can view the updates here.
We will apply the new pooling levels and fees to future renewal calculations that involve Quebec plan members.
If you have any questions, please contact your Group Account Executive or myFlex Account Executive.