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Insights from a pandemic: COVID-19 and group benefits plans
We’ve received numerous questions about the impact of COVID-19 and what it will mean for benefits plans in the months ahead. Below is a summary of what we’re seeing so far. In the coming weeks, we’ll explore each of these topics in greater depth.
Disability
Initially, as COVID-19 started to spread, we saw STD claims ramp up quickly. Since then, we’ve seen the number of COVID-19-related STD claims slow significantly. As for LTD, we believe both the incidence and duration of those claims will increase in both the short term and medium term due to COVID-19.
Health and Dental Claims
We saw an overall spike in the volume and paid amounts for drug claims in March as plan members rushed to stock up on their medications. This was followed by a drop in April after most provinces put 30-day refill limits in place. One exception was claims for asthma drugs which surged in March but had no drop in April. Overall, the April plunge will be short-lived; drug costs have already begun to rise in May.
While paramedical and dental claims are down, we are seeing an increase in claims for virtual treatments and emergency dental services. We expect that claims will spike once the current pandemic restrictions are lifted. We’ve already started to see claims rise in provinces that are allowing health providers to re-open.
Despite the shift to more virtual services, we haven’t seen an increase in fraudulent activity. But we continue to be vigilant. Our investigative practices – verifying with the plan member that they received the treatment and have a valid receipt, and that the practitioner has treatment notes – remain the same whether treatment is provided in person or virtually.
Technology
During this time of physical distancing, people are looking for ways to interact with their providers virtually. Fortunately, our business model is almost entirely electronic, and we have several convenient digital options available for plan members and plan sponsors. Our focus in recent weeks has been to remind clients and plan members about these tools and make it as easy as possible for them to activate and use them. And we are continually adding functionality that will allow us to serve our customers even better.
Mental Health/Wellness
Usage of i-Volve, Homewood’s online cognitive behavioural therapy tool, increased significantly in March before levelling back down in April and May. And while EFAP cases fell in April and early-May, the number of cases has begun to climb in recent weeks, particularly for anxiety. In the coming weeks and months, we expect an eventual increase in marital and family issues, as well as depression. We’ve also seen an increase in mental-health-related prescriptions.
Plan Design
It’s too early to predict how the COVID-19 pandemic will impact benefits plan design and how it will change in the coming months. We would love to get your feedback and insights about how benefit plans will evolve and what new features or provisions they should include.
Please share your thoughts and suggestions with your Group Account Executive or myFlex Marketing Manager. Or, you can email your ideas to GroupCommunications@equitable.ca.
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NEW MARKETING MATERIAL! Flexibility for supplemental income with Equimax
Equitable has created a new piece to help you understand our new Equimax® illustration feature, Paid-Up Additions (PUA) to Cash Dividends, now available!
Did you know Equimax clients can switch from the PUA dividend option to the cash dividend option by simply requesting a dividend option change?1,2
You can illustrate this for paid-up 10 pay and 20 pay Equimax plans! Show clients how they can build in added flexibility and use their policy to create a source of future supplemental income by simply changing the dividend option to cash.3
Illustration Considerations:
● Works with Equimax Estate Builder® or Equimax Wealth Accumulator®.
● Illustrate the Excelerator Deposit Option (EDO) to help build the policy values while the PUA dividend option is in effect. EDO payments can’t be made once the policy is switched to the cash dividend option.
● If a client needs temporary insurance coverage – like mortgage protection - illustrate term riders for how long they are needed to meet the specific goal.3
● If critical illness coverage is needed our competitively priced 20 pay critical illness riders are a great fit to provide paid-up critical illness coverage.3
Clients should apply for the coverage they need. This concept is about flexibility to create a future source of supplemental income.
Want to learn more? Check out our new marketing piece: Flexibility for supplemental income with Equimax (2077).
For more information, reach out to your local wholesaler.
® and TM denote trademarks of The Equitable Life Insurance Company of Canada.
1 Dividends are not guaranteed and are paid at the sole discretion of the Board of Directors. Dividends may be subject to taxation. Dividends will vary based on the actual investment returns in the participating account as well as mortality, expenses, lapse, claims experience, taxes, and other experience of the participating block of policies.
2 To request a change to the dividend option complete and submit form 558 (Request for Withdrawal of Dividends, Change in Option, or Premium Offset). A client can request a change to the cash dividend option from any other dividend option regardless of the premium type or whether premiums continue to be payable, subject to our current administration rules and guidelines. Some dividend option changes are subject to underwriting. Underwriting is not required to change from the PUA to cash dividend option, however, underwriting is required to change from the cash dividend option to the PUA dividend option.
3 This concept is intended to illustrate a one-time switch to cash dividends once premiums are no longer payable for the policy (including premiums for riders). Premiums are paid with after-tax dollars and dividends paid in cash are subject to taxation. If premiums are payable there will be tax savings for the client to use the before-tax cash dividend to reduce the premium instead of taking it entirely as a cash payment. This concept is intended for longer term planning, not to meet short term cash needs by switching back and forth between the PUA and cash options. Clients should consider a policy loan or a cash withdrawal to meet short-term cash needs; policy loans and cash withdrawals may be subject to taxation.
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May 2023 eNews
Update: Introducing changes to our Diabetes Management Program
Beginning June 1, 2023, we are introducing additional standard drug plan controls as part of our Diabetes Management Program.
The controls will apply to GLP-1 agonists approved by Health Canada for the treatment of diabetes, such as: Adlyxine, Mounjaro, Ozempic, Rybelsus, Trulicity, and Victoza.
This change will help manage the impact of these high-cost diabetes medications for your clients while continuing to provide plan members with access to effective treatments to manage their disease.
Why are we introducing this change?
GLP-1 agonists are the highest cost diabetes drugs on the market. Current Diabetes Canada Clinical Practice Guidelines recommend that most Type 2 diabetics begin treatment with lower-cost and equally effective first-line therapies, such as Metformin.
Some GLP-1 agonists are also used “off-label”. In other words, they are often prescribed for conditions for which they have not been approved by Health Canada, such as weight loss.
These additional controls will help ensure that these drugs are used appropriately – only for the treatment of diabetes and only after other first-line treatments have been tried.
If a client wishes to provide coverage for drugs specifically approved by Health Canada for weight loss, we have coverage options available.
How will this program work?
Plan members who receive a new prescription for a GLP-1 agonist will need to try a first-line diabetic treatment before they are eligible for coverage of the GLP-1 agonist. If the plan member has previously tried first-line therapies and found them ineffective, they will be eligible for a GLP-1 agonist.
Plan members who are already taking a GLP-1 agonist to treat diabetes will continue to be eligible for coverage. Some claimants may need to provide confirmation of their diabetes diagnosis from their physician or pharmacist in order to maintain coverage. We will provide claimants ample time to confirm their diagnosis.
Questions?
If you have any questions about these additional standard controls or how they will impact your clients, please contact your Group Account Executive or myFlex Sales Manager.
Coming soon: Survey for plan administrators with recent disability claims
We are regularly enhancing our communication processes to help your clients with disability plans manage their workplace absences more effectively. Later this month, we will distribute a short survey to plan administrators who have submitted a disability claim in the past six months. The survey will ask recipients about their satisfaction with the frequency and detail of our disability management communications.
The email will come from GBClientFeedback@equitable.ca, and the survey will remain open until the end of the day on May 19, 2023. All responses will be confidential. Survey respondents will receive the option to provide their contact information so that we can follow up on feedback they have provided.
We plan to use the feedback to help ensure that we’re meeting your clients’ expectations and delivering industry-leading service.
In a previous issue of eNews, we published a list of the average dental fee increases for general practitioners based on the latest Provincial and Territorial Dental Association fee guides.
Since then, the Canadian Life and Health Insurance Association (CLHIA) has updated the 2023 dental fees for some provinces. Provinces with dental fee updates since our previous eNews are bolded and italicized. Equitable Life uses these guides to help determine the reimbursement limits for dental procedures. For your reference, below is the list of the average dental fee increases for general practitioners that will be used by Equitable Life for 2023.
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