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Group Benefits - Premium relief for Dental and Extended Health Care benefits
We know this is a difficult time for Canadian employers and that many of your clients are facing financial hardship as a result of the COVID-19 pandemic. We continue to look for ways to help employers manage while still supporting their employees.
With many health practitioners closing their offices due to the pandemic restrictions, plan member use of dental benefits and some health benefits has declined.
So, we are pleased to announce that we are offering premium relief for all Traditional and myFlex insured non-refund customers for Health and Dental benefits, as follows:
- A 50% reduction on Dental premiums; and
- A 20% reduction on vision and extended healthcare rates (excluding prescription drugs), which equates to an 8% reduction on Health premiums.
These reductions are retroactive to April 1, 2020 and will appear as a credit against the next available billing. We will assess the situation monthly and expect to continue with monthly refunds for as long as the current crisis period continues.
We expect that claims experience and premiums will return to normal once the current pandemic restrictions are lifted.
In the meantime, plan members will continue to have full access to their benefits coverage throughout the pandemic. In many cases, dental offices remain open for emergency services, and a variety of healthcare providers are available virtually.
Commissions
We know the pandemic has put financial strain on your business as well, so we will continue to pay full compensation. Although your overall commission will be unaffected by these premium reduction adjustments, you may see a temporary reduction in your commission payments if you are on a pay-as-earned basis while we put through mass changes. If so, we will then make an additional top-up payment to cover that shortfall as soon as we are able.
Communication
We will be communicating this premium relief program to your clients April 21st at 8:00am EST.
A PDF of the communication is also available here.Questions?
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager. In the meantime, we have provided some Questions and Answers below.
Will the premium reduction on Health and Dental benefits have an impact on the renewals that were deferred?
No. Renewals will proceed as normal, with rate adjustments based only on months where full premium was paid. For most clients, we anticipate “normal” rate adjustments at renewal compared to rates paid prior to refunds taking effect.
Does this adjustment apply equally to clients who have had their renewal deferred?
Yes, these adjustments apply to all Traditional and myFlex insured, non-refund customers for Health and Dental benefits.
How does this affect clients who have terminated or amended a plan?
If a benefit is in-force during the month of April, the adjustment will be credited to the next available billing. For clients who have temporarily terminated all benefits, this will be applied against the first bill once benefits have been reinstated. No cash refunds will be paid.
Will you recover any of the adjustment at a future point in time?
No, we will not recover this adjustment.
Instead of this premium reduction adjustment, can a client cancel or adjust some of the benefits on their plan?
Yes, you and your clients always have the option of changing the coverage on a plan, such as reducing or removing a benefit to help control costs. Please speak to your Group Account Executive or myFlex Sales Manager about the options available.
Are TPAs and self-administered groups eligible for the premium reduction?
Yes. TPAs and self-administered groups are eligible for the premium reduction. However, timing for the credit will be dependent on the billing practices of the TPA or self-administered group. We will apply these credits as soon as we are able. -
Equitable Life Group Benefits Bulletin – November 2020
In this issue:
- Telemedicine now included in Travel Assist*
- Take advantage of our convenient digital options*
- 2021 changes to Maximum Insurable Earnings, Maximum Weekly Insurable Earnings and Short Term Disability Benefit*
*Indicates content that will be shared with your clients
Telemedicine now included in Travel Assist*
Medical emergencies can be particularly stressful while travelling. Making your way to a medical facility can be a struggle. And once you get there, you could face long wait times, language barriers or even the risk of COVID-19 infection.
That’s why Allianz Global Assistance®, our Travel Assist provider, is adding two new virtual care options to provide plan members with timely and appropriate medical support.
As always, when a travel medical emergency strikes, plan members call Allianz for assistance. During the intake process plan members will be guided through a series of questions to triage their unique medical situation. Options for care now include two different virtual care services:
- TeleConsultation – Video and chat consultation with a locally licensed physician. This physician can diagnose simple medical conditions and provide a prescription. Available across Canada and in some high travel states in the United States.
- TeleAdvice – Video and chat consultation for situations which are not likely to require a prescription. The physician can diagnose simple medical conditions and provide medical guidance.
Plan members who use virtual care may benefit from:
- Reduced wait times;
- Care from the comfort of their current location;
- Reduced language barriers;
- No need to arrange transportation to a medical facility;
- Reduced impact on travel itinerary; and
- Reduced risk of exposure.
Both TeleConsultation and TeleAdvice will be available for all Equitable Life plan members beginning January 1st, 2021. There is no additional cost, no changes required to your client’s plans, and no change to the way plan members contact Allianz in the event of a travel medical emergency.
This PDF plan member update will also be included in the eNews to plan administrators.
If you have any questions about these new features, please contact your Equitable Life Group Account Executive or myFlex Sales Manager.
Allianz Global Assistance is a registered business name of AZGA Service Canada Inc. and AZGA Insurance Agency Canada Ltd.
Help your clients take advantage of our convenient digital options*
During this time of physical distancing, people are looking for ways to interact with their providers virtually. We recently enhanced our Online Plan Member Enrolment tool, allowing all groups to add new plan members without the need for paper forms.
Did you know, we have several other digital options available to make it easier for your clients to do business with us and for their plan members to access and use their benefits plan? Over 71% of plan administrators are managing their plan online and 78% of plan members are already using our digital tools.
For plan administrators:
- Plan Administrator Portal (EquitableHealth.ca) – plan administrators can easily manage their plan anytime and anywhere
- Digital Welcome Kits – personalized welcome kits are delivered to plan members via email
- Easy automated payments – plan administrators can avoid missed payments by setting up pre-authorized debit or electronic funds transfer
For plan members:
- Plan Member Portal (EquitableHealth.ca) – plan members get secure, 24/7 access to their claims history, coverage details and health and wellness resources
- Electronic Claim Payments and Notifications – plan members can get claim updates sooner in their email inbox and payments right into their bank account
- EZClaim Mobile App – submitting claims from a mobile device is fast, easy and secure
- Digital Benefits Cards – plan members no longer have to dig through their wallet – they can download their benefits card on their mobile device
Learn more about how we’re making it easier for your clients to do business with us
2021 changes to Maximum Insurable Earnings, Maximum Weekly Insurable Earnings and Short Term Disability Benefit*
The Canada Employment Insurance Commission and Canada Revenue Agency have announced the 2021 changes to Maximum Insurable Earnings, and premiums for employment insurance. These changes take effect January 1st, 2021.
Maximum Insurable Earnings (MIE)
The MIE will increase from $54,200 to $56,300.
Maximum Weekly Insurable Earnings (MWIE)
The MWIE will increase from $1,042 to $1,083.
EI Benefit (55% of the MWIE, rounded to the nearest dollar)
EI benefit will increase from $573 to $595
Information for Plan sponsors
If your client’s Group Policy with Equitable Life includes a Short Term Disability (STD) benefit which is tied to the EI MWIE, and at least one classification of employees has less than a $595 maximum:
- To comply with the provisions of their policy, their STD benefit will be revised with the maximums updated based on the percentage of EI MEIW shown in their policy.
- The additional premium for any increase from their previous STD amounts and new STD amounts will be show on their January 2021 Group Insurance Billing (as applicable).
If their STD maximum is currently higher than $595 or based on a flat amount (not based on a percentage or regular earnings):
- No change will be made to their plan unless otherwise directed.
If your clients wish to provide direction regarding revising their STD maximum, or have questions about the process, they can email Kari Gough, Manager, Group Quotes and Issue.
*Indicates content that will be shared with your clients
-
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.