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January 2023 eNews
Responding to Saskatchewan’s biosimilar switch initiative*
We are changing coverage for some biologic drugs in Saskatchewan 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.
Saskatchewan’s provincial biosimilar initiative
Announced in October 2022, the Saskatchewan Biosimilars Initiative ends coverage of ten biologic drugs beginning on April 30, 2023.
Patients in the province who are using these drugs will be required to switch to biosimilar versions of these drugs by April 30, 2023, in order to maintain their Saskatchewan Drug Plan 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 Saskatchewan for most biologic drugs included in the provincial initiative.
Beginning April 30, 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.
Communicating this change to plan members
We will inform any affected plan members in early February 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 Saskatchewan includes more biologic drugs in its biosimilar initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.
Ontario announces 2023 biosimilar switch program*
The government of Ontario recently announced the launch of a biosimilar initiative to switch patients from eight originator biologic drugs to biosimilar versions of the drugs.
Patients in Ontario using affected originator biologic drugs will have until December 29, 2023 to switch to a biosimilar version of their medications in order to maintain coverage under the province’s public drug plans.
We are actively monitoring and investigating the impact of this new policy on private drug plans in Ontario. We plan to implement changes to coverage of biologic drugs in the province in 2023 to help prevent this change from resulting in additional costs for our clients’ drug plans. We will provide more details in the coming months.
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager.
Dental fee guide updates*
Each year, Provincial and Territorial Dental Associations publish fee guides. 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.***Dental fee guide increases over 2022***
***Data for all provinces and territories was not available at the time of publication. This chart will be updated on EquitableHealth.ca as more information becomes available.
Equitable Life ranks high with Canadian group advisors*
Equitable Life ranked second nationally and first in Ontario among major insurers in a recent survey of Canadian group benefits advisors.
NMG Consulting, a leading global consulting firm, conducted in-depth interviews with 130 leading group consultants, brokers and third-party administrators across the country between May and August 2022 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 Life ranked either first or second in four of the six main categories:
Advisors in Ontario, in particular, scored Equitable Life very favourably. We ranked #1 overall in the province, finishing first in four of the six overall categories, including: Relationship Management, Operational Management, Underwriting and Claims Management and Technology.
“The fact that advisors regard us so highly in so many categories is a testament to our mutual status and our ability to focus exclusively on our clients and advisors,” said Marc Avaria, Senior Vice President of Group. “We are truly working together to build strong, enduring and aligned partnerships.”
“While we are happy with these results, we won’t rest on our laurels,” added Avaria. “We will continue to dedicate ourselves to providing our clients and advisors with a better benefits experience.”
Here are more of the highlights from this year’s results:
Nationally, we ranked first in all 10 subcategories in Operational Management, including:- Overall service to intermediaries,
- Overall service to plan sponsors,
- New quote process,
- Plan implementation,
- Renewal process,
- Information shared at renewal,
- Accuracy and timeliness of reporting and billing,
- Administration quality and responsiveness,
- Taking ownership and
- Management information quality and availability.
- Company relationship management,
- Ease of doing business,
- Account executive capability,
- Market knowledge,
- Visit/call quality,
- Effective coordination and
- Advice.
- Fairness and timeliness of disability claims (1st)
- Fairness and timeliness of health claims (2nd)
- Fraud management (2nd)
- Competitiveness of pooling charges (2nd)
- Group underwriting flexibility (3rd)
- Health and dental TLR competitiveness (3rd)
- Overall technology – Intermediary (2nd)
- Member experience (2nd)
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Enhanced flexibility and features make Equimax whole life a great choice for your clients
WHAT’S NEW ON MARCH 23, 2020?
The following features are available on Equimax Estate Builder® and Equimax Wealth Accumulator® plans!
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60 months of EDO payment flexibility1 that fits your clients’ situation- Clients can start EDO payments1 up to 60 months from the date the application was signed, or resume up to 60 months from the last EDO payment made, without additional evidence of insurability.
- Applies to Equimax2 policies with an effective date of March 23, 2020 or later.
EDO is available on cases rated 300% or less3 for new and existing clients- For existing clients, if approved, the EDO contract provisions that apply will be based on the effective date of the insurance policy, not the date the EDO was added.
- Applies to Equimax2 policies issued under the 2017 tax rules.
Built-in Disability Benefit Disbursement provides access to cash value in the event of a disability
- The Disability Benefit Disbursement may provide a tax-free, lump sum payment of up to 100% of the policy’s cash value if the insured becomes disabled.4
- Will be included on Equimax2 policies issued under the 2017 tax rules.5
Want more information?
More information is available on EquiNet® on the Whole Life Insurance Product page under the Resources tab.
Ask your Equitable Life® Regional Sales Manager about Equimax today.COVID-19 & social distancing: Strategy for insurance applications
Using our EZcomplete® online application allows you to keep your distance … while keeping your business moving forward.
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1 This applies only to policies with an effective date of March 23, 2020 or later. The amount of the EDO payment allowed may be limited to the maximum EDO payment made in previous years depending on the policy year. For approved EDO amounts exceeding $150,000 annually ($12,500 monthly), clients have up to 12 months from the date the EDO application was signed or the date of the last EDO payment to make an EDO payment before a contribution cap may apply. See Admin Guide for full details. 2 Applies to Equimax Estate Builder and Wealth Accumulator; all ages; life pay and 20 pay; single and joint lives. 3 Not available if the policy has a flat extra rating. 4 See sample policy contract for full details, including the qualifications for the disbursement. Policy cash value and death benefit will decrease. Tax laws are subject to change. The payment of the disability benefit disbursement may affect the adjusted cost basis (ACB) of the policy as it is considered payment of a capital benefit. Changes in ACB can affect the future taxation of the policy. 5Subject to our administrative rules and guidelines in effect at the time of the disbursement -
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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2024 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.
Thank you for your support this past year and for trusting Equitable with your Individual Insurance and Savings & Retirement business. Happy Holidays!
Client Care Centre Holiday Hours
Friday December 6, 2024 - CLOSED
Tuesday December 24, 2024 - 8:30 a.m. – 11:00 a.m. ET
Wednesday December 25, 2024 – CLOSED
Thursday December 26, 2024 – CLOSED
December 27, 30 and 31, 2024 - 8:30 a.m. – 7:30 p.m. ET
Wednesday January 1, 2025 - CLOSED
Savings & Retirement
All transaction requests to be handled same business day must be submitted in good order by:
● December 24, 2024, 11:00 a.m. ET
● December 31, 2024, 11:00 a.m. ET
FHSA applications to be considered for 2024 contribution year must be submitted in good order by:
● December 31, 2024, 11:59 p.m. ET
FHSA online banking deposit deadline for 2024 contribution receipt:
● December 24, 2024, 4:00 p.m. ET Note: Transaction requests submitted after 11:00 a.m. ET will be processed effective next business day
RRSP deposits to be considered for the 2024 tax year must be:
● Dated March 3, 2025, or before
● Must be submitted to Head Office in good order by March 7, 2025, by 4:00 p.m. ET
RRSP applications to be considered for 2024 contribution year must be submitted in good order by:
● March 3, 2025, 11:59 p.m. ET
RRSP B2B Loans:
● RRSP loan deposits must be received by March 14, 2025, by 4:00 p.m. ET
Note: Transactions submitted after these dates will not receive a 2024 contribution receipt
Individual Insurance
Underwriting
● Underwriting must receive all evidence and outstanding Underwriting requirements by December 9th at the latest. Underwriting will then be able to decision these cases by December 16th. This will give the New Business team December 13th – December 31st 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 31st. 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 2024 – December 11, 2024 to December 17, 2024 (Transmission/Statement date December 18, 2024)
● Last Pay Period of 2024 – December 18, 2024 to December 31, 2024 (Transmission/Statement date January 2, 2025)
● First Pay of 2025 – January 1, 2025 to January 7, 2025 (Transmission/Statement date on January 8, 2025)
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.
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