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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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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.