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Equitable Life Group Benefits Bulletin – September 2021
In this issue:
- Right drug, right dose*
- Responding to New Brunswick’s Biosimilar Initiative*
- Helping plan members access our convenient digital options*
- Reminder: Please access forms on EquitableHealth.ca*
- Over-age dependents losing coverage?*
Right drug, right dose
Equitable Life partners with Personalized Prescribing Inc. to help plan members avoid treatment trial and error
Patients suffering from mental health conditions often need to try several medications before they find one that works for them. This is frustrating and can result in negative side-effects, a longer recovery, lost productivity, or a delayed return to work.
To help plan members avoid this treatment trial and error, we have partnered with Personalized Prescribing Inc. to provide easier access to pharmacogenomic testing for plan members with mental health conditions.
Pharmacogenomics 101
Pharmacogenomics is the study of how an individual’s genes influence their response to medications. Pharmacogenomic testing can help determine how compatible a patient’s body may be to a particular drug, and helps their physician prescribe the most appropriate medication. The goal is to ensure the right drug is prescribed to deliver the most positive outcome with the fewest side effects.
Easier access to pharmacogenomic testing
Through our partnership with Personalized Prescribing Inc., any Equitable Life plan member diagnosed with a mental health condition can purchase a pharmacogenomic test for a discounted price of $399 plus HST – a 20% savings.
We are also introducing the option for plan sponsors to add coverage of pharmacogenomic tests provided by Personalized Prescribing Inc. for mental health conditions.
With this coverage, plan members are eligible for pharmacogenomic testing if:- They have been diagnosed with a mental health condition;
- They are currently taking or have stopped taking a medication for a mental health condition that does not work or has side effects; and
- The pharmacogenomic test is conducted by Personalized Prescribing Inc.
Getting a test is easy. The plan member starts by visiting www.personalizedprescribing.com/equitablelife to request a test kit.
Once they receive their test kit from Personalized Prescribing Inc., they simply provide a saliva sample and send it back (postage is pre-paid). Within 7-10 business days, they receive an Rx Report™ that they can share with their doctor. This report includes details to help their doctor prescribe the right drug and the right dose for them.
Benefits for plan members:- The plan member and their physician receive a full report that is easy to understand;
- The report identifies the most compatible medications for the plan member’s condition and the medications to avoid;
- The physician is able to prescribe the most appropriate medication with the fewest side effects; and
- The plan member avoids medication trial and error.
- Pharmacogenomic testing can be an effective prevention strategy to help employees stay healthy and potentially avoid a mental health-related work absence; and
- Employees suffering from mental health conditions may be more productive when they are on the right medication for them.
Responding to New Brunswick’s Biosimilar Initiative
We are changing coverage for some biologic drugs in New Brunswick in response to the province’s Biosimilar Initiative. These changes will help protect your clients from additional drug costs while still providing access to equally safe and effective biosimilars.
What is New Brunswick’s Biosimilar Initiative?
New Brunswick’s Biosimilar Initiative will end provincial coverage of several originator biologic drugs for some or all conditions beginning on December 1, 2021. Patients who are using these drugs for the affected conditions will be required to switch to biosimilar versions of the drugs to maintain coverage under the province’s government drug plan.
What is the impact on private drug plans?
The most significant risk to plan sponsors who maintain coverage of originator biologics is coordination of benefits (CoB) risk. If other insurance carriers follow suit with the province and delist the originator biologics, it could expose a plan that doesn’t delist them to significant coordination of benefits risk.
For example, consider a patient who is covered under two private plans – their employer plan and a spousal plan. If their employer plan was the first payer for the originator biologic but delists the drug, the spousal plan now becomes the first payor. If the spousal plan continues to cover the cost of the originator, it now pays most or all of the cost of the drug.
How is Equitable Life responding?
To protect your clients’ plans from paying additional and avoidable drug costs, we are changing coverage in New Brunswick for most biologic drugs included in the provincial initiative.
Beginning Feb. 1, 2022, plan members in New Brunswick will no longer be eligible for coverage of Humira, Lantus, Humalog and Copaxone 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 those drugs to maintain coverage under their Equitable Life plan.
How will Equitable Life communicate this change to plan members?
We will be communicating with affected claimants in early-December 2021 to allow them ample time to change their prescriptions and avoid any interruptions in their treatment or their coverage.
Can my client maintain coverage of these biologic drugs?
All groups, except myFlex clients, who wish to opt out of this change and maintain coverage of these originator biologics for New Brunswick plan members can submit a policy amendment. Amendments must be submitted no later than Nov. 30, 2021.
Advisors with myFlex Benefits clients who wish to maintain coverage of these originator biologics for New Brunswick plan members should speak to their myFlex Sales Manager to confirm their eligibility to opt out of this change.
Groups that opt out of this change are also opting out of any future changes to our New Brunswick biosimilar initiative. Their drug plans will continue to cover any additional originator biologics that we subsequently add to the program.
Will this change impact my clients’ rates?
The rate impact of this change and 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.
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 also known as the “originator” biologic. Biosimilars are also biologics. They 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.
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
Helping plan members access our convenient digital options
Some of your clients’ plan members aren’t benefitting from our secure and convenient digital options to access and use their Group Benefits. They can sign up to submit claims electronically for faster claim payments, get claim payments deposited directly to their bank accounts, easily review their coverage details, quickly access their Group Benefits plan booklet, benefits card and more. We’ve made it easier than ever to sign up, with more resources all conveniently located at Equitable.ca/go/digital.
Your clients’ plan members can visit this link to view:- A brochure with all the high-level instructions they need to get started on EquitableHealth.ca and the EZClaim mobile app
- A full video guide on how to access and navigate EquitableHealth.ca
Reminder: Please access forms on EquitableHealth.ca*
We routinely update our Plan Administrator forms on EquitableHealth.ca based on their feedback and to stay compliant with legal and/or regulatory requirements. If your clients need a form, they should always pull the most recent version from EquitableHealth.ca instead of reusing forms they have saved on their computer. Using an old or outdated form may result in processing delays.
Your clients can access the Plan Administrator forms by following these steps:- Login to EquitableHealth.ca
- Select “Documents”
- Toggle between English and French forms
- Click on the document name to download a PDF copy
Over-age dependents losing coverage?*
Some of your clients’ plan members may have dependents who are reaching the maximum age for eligibility under their group benefits plan.
If they are attending school full-time or are disabled, they may be eligible for continued coverage. Plan members with over-age dependents can simply complete the Application for Coverage of Dependent Child Over Age 21 (Form #441) and submit it through our online document submission tool. They can access the tool by logging into their Group Benefits account at www.equitablehealth.ca and clicking My Resources.
If they are not attending school full-time or disabled, they will no longer be covered under the plan. However, they may be eligible for Coverage2go®. It allows individuals who are losing their group coverage to purchase personal month-to-month health and dental coverage that is affordable, reliable and works like their previous group benefits plan. They can choose the level of coverage and protection that suits their personal situation.
There are no medical questions – they simply need to apply within 60 days of losing their health coverage under their group benefits plan.*
Help your clients’ plan members and their dependents who are losing coverage by letting them know about Coverage2go. They can visit our website to learn more about Coverage2go and to get a quote.
*Quebec residents are not eligible for Coverage2go - COVID-19 Group Benefits FAQ
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Individual Insurance product enhancements
Equitable Life has exciting product enhancements that will help you offer more options to clients.
- Full Product Launch Video (approx. 20 minutes).
Watch our Virtual Product Launch NOW. Grab a coffee and get ready for this exciting news! Hear from our leaders and learn about our exciting product enhancements.
- Introduction video (View on Vimeo) / Product launch page
Highlights of the product changes effective February 12, 2022, include:NEW! 10 pay premium option with Equimax Estate Builder®
- The new EquiLiving® 20 pay rider options will be available on Equimax® plans
- 20 pay options with coverage to age 75 or coverage for life
NEW! EquiLiving plans and riders enhanced with:
- Support from Cloud DX to help monitor a client’s well-being from treatment to recovery.
- Added Acquired Brain Injury as a covered critical condition
- 30-day survival period removed for all non-cardiovascular covered conditions
- No age restriction to claim for Loss of Independent Existence (LOIE)
- EquiLiving Benefit now pays the higher of the EquiLiving Benefit or the Return of Premium Rider Benefit (not including Return of Premium on Death)
- And so much more …
New Illustration software available on February 11, 2022
The updated illustration software will be available for download after 9 a.m. ET on Friday, February 11, 2022, and will include all the Equimax and EquiLiving enhancements.
See the Equitable Sales Illustrations Update for information on how to download the software or check for updates.
Please review updates to the commission schedule A for these new enhancements.
Learn more- Transition rules are available
- Watch our virtual launch event video now! (Approx. 20 minutes),
- Watch our product launch intro video here. Watch on Vimeo
- Visit our launch event page with product change details and more
- Marketing Materials
Please contact your Regional Sales Manager for more information. - [pdf] Equitable HealthConnector
- [pdf] Consent and Authorization for Release of Medical Information to Advisor
- [pdf] A better group benefits experience
- Path to Success Module 4
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Let’s talk about Critical Illness insurance, the Equitable way.
Having critical illness insurance benefits in an important time of need is so valuable. Get the right critical illness insurance coverage for your clients.
In 2022, we made some significant updates to our EquiLiving® Critical Illness insurance plans to provide better choices and features for clients.
These significant updates included:
● The addition of Acquired Brain Injury as a covered condition
● The addition of 20 pay options allowing more choice when choosing the right plan for your clients
● The removal of the age restriction for juveniles to claim for Loss of Independent Existence
Plus, a Canadian first, the addition of Cloud DX. Cloud DX is a value-added service that provides remote patient monitoring to claimants in addition to the full critical illness benefit paid by Equitable Life®. Cloud DX delivers medical grade hardware directly to the client so that Cloud DX can remotely monitor their vitals to help ensure they are on and stay on the road to recovery.
View our new Critical Illness video on YouTube or Vimeo!
With these updates and more, EquiLiving Critical Illness Insurance is there for clients, not only at time of their claim but also during their recovery. To learn more about Critical Illness insurance, the Equitable way, contact your local wholesaler.
*Cloud DX is a non-contractual benefit and may be withdrawn or changed by Equitable Life® at any time. To be eligible for the Cloud DX offering, a claimant must be age 12 or older and have received payment on or after February 12, 2022 for a covered critical condition benefit under an individual critical illness insurance policy issued by Equitable Life. An early detection benefit payment does not qualify. Equitable Life pays for 6 months of Cloud DX subscription fees. If the claimant wishes to continue the Cloud DX service after 6 months, they will be responsible for the cost.
® and TM denote trademarks of The Equitable Life Insurance Company of Canada.