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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. -
January 2024 eNews
In this issue:
- Equitable scores high marks with group advisors*
- REMINDER: Equitable's National Biosimilar Program starts in March*
- 2024 dental fee guide updates*
- Homewood Health wins HR Reporter Reader's Choice award for EFAP excellence*
Equitable scores high marks with group advisors*
Equitable ranked first for operational service among major group insurers in a recent study of Canadian group benefits advisors.
NMG Consulting, a leading global consulting firm, conducted in-depth interviews with 146 Canadian group benefits brokers, consultants, MGAs and third-party administrators between May and August 2023 for its annual Canadian Group Benefits Study. Based on these interviews, NMG ranked group insurers in six categories, ranging from operational management to technology.
Nationally, Equitable ranked among the top three in five of the six main categories, including number one for Operational Management:Category Ranking Operational management 1st Initiatives (including seminars & training) 2nd Technology 3rd Underwriting & claims management 3rd Relationship management 3rd
“Advisors regard us highly in many categories. That’s a testament to our mutual status and ability to focus exclusively on our clients and advisor partnerships,” said Marc Avaria, Executive Vice President, Group Insurance Division. “We are truly working together to build strong, enduring and aligned partnerships with our clients and advisors.”
“We’re delighted with these results and are committed to continuously advancing our delivery of a better benefits experience for our clients and advisors,” added Avaria.More highlights from the latest NMG survey
Nationally, we ranked first in seven subcategories in Operational Management, including:- Overall service to intermediaries,
- Overall service to plan sponsors,
- New quote process,
- Plan implementation,
- Renewal process,
- Accuracy and timeliness of reporting and billing, and
- Administration quality and responsiveness
And we were rated strongly in Technology, finishing in the top three for:- Overall technology for Intermediary (2nd)
- Member experience (3rd)
- Quality of technology for the plan sponsor (2nd)
- Quality of mobile application (2nd)
REMINDER: Equitable's National Biosimilar Program starts in March*
In October 2023 we announced the upcoming launch of our national biosimilar program. Starting March 1, 2024, we are expanding our biosimilar switch initiatives to provide a single, nationwide** program.
Why we’re making the switch
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.
Equitable’s National Biosimilar Program simplifies drug plan coverage by replacing our provincial programs. It also protects clients from additional drug costs while offering access to lower-cost biosimilars deemed equally safe and effective by Health Canada.
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. It will also affect 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.
Advance notice for plan members
We contacted affected claimants in early December to give them enough time to change their prescriptions 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.
2024 dental fee guide updates*
Each year, Provincial and Territorial Dental Associations publish fee guides. Equitable uses these guides to help determine the reimbursement limits for dental procedures.
For your reference, you may wish to refer to the 2024 list of the average dental fee increases for general practitioners.
Homewood Health wins HR Reporter Reader's Choice award for EFAP excellence*
Equitable is proud to congratulate our Employee and Family Assistance Plan (EFAP) partner, Homewood Health®, for winning the Canadian HR Reporter 2023 Reader’s Choice Award in Employee Assistance Plan services. Homewood’s EFAP provides confidential support for a range of health, family, money, and work issues through face-to-face, phone, email, chat, or video counselling. The award recognizes their high standards in counselling and mental health support services.
The annual Reader’s Choice Awards identify organizations that provide outstanding expertise and services for HR professionals and employers across Canada. Those organizations provide valuable information on useful, innovative HR and employee benefits products and programs, in categories such as recruitment, mental health services, employee engagement programs, and more.
Sharing Homewood Health with your clients
Since 2019, we have worked with Homewood to provide mental health services for Equitable benefits plan members.
Your clients can access Homewood Health’s award-winning EFAP for an additional fee by adding it to their benefits plan. Services are available 24/7, 365 days a year.
All Equitable clients also have free access to Homewood Health Online in their benefits plan. Homewood Online provides a variety of helpful wellness resources, including:
- Homeweb, an online and mobile health and wellness portal,
- Health Risk Assessment, a group of assessment tools to help plan members identify and overcome health and wellness barriers, and
- Online Internet-based cognitive behavioural therapy (iCBT) through Sentio to manage symptoms of anxiety and/or depression.
Questions
To learn more about Homewood Health’s services, contact your Group Account Executive or myFlex Account Executive.
- Contracting and Compensation
- Updates
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Important information regarding use of the form 350 Application for Life and/or Critical Illness Ins
As of February 12, 2022 the new version of the form 350 (2022/02/12) was available on EquiNet® (Individual Insurance>Forms), and can be ordered from our Supply department using form 1390 Supply Order Form (Life and Health)
To apply for the new 10 pay premium option on Equimax Estate Builder, or the new EquiLiving plans or riders, the new version of the form 350 (2022/02/12) Application for Life and/or Critical Illness Insurance must be used. The new version of the 350 will include the option to select the new features.
We will not accept the 350 (2021/04/02) version of the application with a hand-written note indicating the new 10 pay premium option, or the new EquiLiving plans or riders.
After March 31, 2022, we will no longer accept the 2021/04/02 or earlier version of the 350 application for any life or critical illness products. - [pdf] Ownership Change Form
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2023 Holiday Hours
The Holiday season brings thoughts of gratitude, and there is no better time to express our thanks and sincere appreciation for your dedication and commitment to Equitable Life.
Thank you for your support this past year and for trusting Equitable Life with your Individual Insurance and Savings & Retirement business. Happy Holidays!
Client Care Centre Holiday Hours
Friday December 22, 2023 - 8:30 a.m. – 7:30 p.m. ET
Monday December 25, 2023 – CLOSED
Tuesday December 26, 2023 – CLOSED
December 27, 28 and 29, 2023 - 8:30 a.m. – 7:30 p.m. ET
Monday January 1, 2024 - CLOSED
Savings & Retirement
To settle on December 22, 2023, the transaction must be received that day by 11:00 a.m. ET
To settle on December 29, 2023, the transaction must be received that day by 11:00 a.m. ET
Individual Insurance
Underwriting
● Underwriting must receive all evidence and outstanding Underwriting requirements by December 15th- at the latest. Underwriting will then be able to decision these cases by December 21st. This will give the New Business team December 21st – December 29th to issue and settle policies.
New Business
● New Business will continue to process all issue and settle requirements every business day until the last working day of the year – December 29th. New Business needs to receive ALL final settle documents in Good Order within our posted service standards. We are currently operating at a 3 business day turn around time.
Field Payroll
● Second Last Pay Period for 2023 – December13, 2023 to December 19, 2023 (Transmission/Statement date December 20, 2023)
● Last Pay Period of 2023 – December 20, 2023 to December 29, 2023 (Transmission/Statement date January 2,2024)
● First Pay of 2024 – January 1, 2024 to January 9, 2024 (Transmission/Statement date on January 10,2024)
Daily Pay will run on business days.
Please note that all requirements must be received in Head Office by the above dates to guarantee settlement for year end.