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1. EAMG Market Commentary April 2024 April 2024
    
   Rates & Credit – Interest rates increased in Q1 2024, giving back half of the decline experienced in Q4 2023 amid consistently positive surprises in U.S. economic data.  The positive economic news also drove a strong risk-on tone to the market, with the risk premium on corporate bonds tightening as economic prospects improved.  In Canada, corporate bonds outperformed government bonds and the broader FTSE Canada Universe Index (FTSE) with a slightly positive 0.07% return, verses a loss of 1.66% in government bonds and a loss of 1.22% for the overall index.  More interest rate sensitive long-term bonds experienced the largest decline, which was partially offset in corporate bonds by the risk-on tone to corporate bond spreads.  On a 6-month and 1-year basis, the FTSE remained positive at 6.94% and 2.10%, respectively.  Within corporate bonds, lower-rated BBBs outperformed higher-rated A bonds, while industries with higher interest rate exposure such as infrastructure, energy, and communications underperformed those with less exposure (notably financials and securitization).
   
   
    
    
   Equity Overview – Throughout Q1 2024, concerns about a recession gradually eased as central bankers adopted a more accommodative outlook on monetary policy. Their growing dovishness reflected confidence that the restrictive monetary measures were effectively curbing inflation as anticipated. Underpinned by prospects of an economic soft-landing, global equity markets rallied to start the year with most major North American indices soaring to new all-time highs during the quarter. U.S. equities continued to outperform other major international markets with the S&P 500 returning 10.6% in USD terms. Major developed economies from Europe, Australasia, and the Far East (EAFE) gained 10.1% in local currency terms, while the TSX added 6.6%. Furthermore, the U.S. economy continued to prove more resilient than most major developed economies, with strong employment and robust output data. As such, foreign investors of U.S. denominated securities achieved enhanced returns, benefitting from a stronger Greenback.
   
    
   U.S. Fundamentals – Corporate earnings beat expectations in Q4 2023, triggering a wave of upward earnings revision. Stable operating margins, cash flows and debt loads continue to attract investors into equities. Investors appear focused on the company’s ability to sustain debt levels ahead of renewing debt obligations. We observed that the number of major companies that expect improving financial performance shrunk to ~19%. This suggests that concentration risks are likely brewing in the equity market, yet again.
    
   U.S. Quant Factors
   Optimistic run-up in equity valuations were mostly driven by the momentum factor. A basket of companies with positive price trends intensified concentration risk in the equity market. We note that momentum factor’ performance sharply contrasted fundamental factors, making us cautious on the market’s complacency. For context, high quality companies, which is typically defined by high Return on Equity (ROE), stable earnings variability, and low financial leverage, placed second in our risk-adjusted performance rankings, and is dwarfed by the ~ 17.9% return observed from the momentum factor.
    
   Canadian Fundamentals – Against the backdrop of underwhelming financial results, ROE – a gauge of how efficiently a corporation generates profits – rebounded in Q4, 2023, after declining throughout most of the year. The improved efficiency metric provided a positive catalyst for dividend investors as the inverse movements of ROE relative to financing costs over 2023 kept investors on the sidelines. In addition, the CRB Raw Industrials Index, a measure of price changes of basic commodities, broke out of recent ranges, providing a tailwind for Canada’s energy and materials sector. Concerns with earnings contraction and macro-economic conditions have subsided.
    
   Canadian Quant Factors – Crude prices soared higher in Q1 2024, with ongoing production cuts from OPEC+ and ramifications of geopolitical conflicts keeping oil markets undersupplied. As such, energy companies benefitted, surging higher and outperforming the broader index, while the low volatility basket – with lower exposure to cyclically sensitive business – underperformed into quarter end. Furthermore, Canadian banks underperformed to start the quarter, giving back some of the sharp outperformance witnessed into the end of Q4 2023. That said, soft inflation data increased expectations of impending rate cuts from the Bank of Canada and, as such, banks performed in line with the broader market throughout most of the quarter. Underpinned by expectations of a dovish switch in monetary policy, investors rewarded dividend payers with a history of increasing dividends, boosting confidence in their ability to support future dividend growth. It is important to note that investors should not let dividend growth’s outperformance overshadow high dividend paying companies’ underperformance; more specifically, investors remain attentive to the businesses’ ability to create value relative to financing costs.  
   
   Views From the Frontline
    
   Rates – Interest rates in both Canada and the U.S. increased across all bond tenors in Q1 2024. U.S. inflation data surprised to the upside, remaining stubbornly higher than hoped, while labour market and consumer indicators underscored the economy's continued strength.  In Canada, inflation data fell below forecasts, but early 2024 GDP readings exceeded expectations. The market now anticipates a 'soft landing' for the U.S. economy; however, the Canadian economy continues to slow. North American central banks have signaled that we are at the peak for policy rates. The market is currently pricing in approximately two-to-three, 25 basis point interest rate cuts by the U.S. Federal Reserve in the second half of 2024, much fewer than the six-to-seven 25 basis point interest rate cuts that the market had been anticipating even just three months ago.  As the Swiss central bank led the way with the first rate cut among developed countries, central banks in major developed economies will closely monitor upcoming data and market developments to determine the timing and pace for rate cuts.
    
   Credit – The risk premium for corporate bonds (versus government bonds) continued to tighten over the quarter, with a strong risk-on tone to the market as investors priced in renewed economic growth in 2024 as compared to previous expectations.  Corporate bond supply was robust, with $38.2bn in new issuance, the second strongest first quarter on record.  On the balance, we do not think the current risk premium adequately compensates for downside risk, particularly in longer-dated corporate bonds, and have a bias towards shorter-dated credit where we view the risk / reward dynamic as being more favourable.
    
   Equity – We favour a combination of the Dow Jones and the S&P500 for our broad market exposure. The Dow, a price-weighted index, should have some value and low volatility tilt as it tracks mature large companies.  As explained above, concentration risks are brewing in the equity market, and during Q1 this risk was exacerbated by investors rushing into a basket of companies with positive price trends, thereby pushing valuation metrics further into the expensive territory.  In our view, it is well-suited to use a combination of the Dow Jones Industrial Average and the S&P 500 for broad U.S. market exposure given the heightened concentration risk. Looking forward, we expect companies to exhibit stable operating margins and therefore, we are shifting our focus toward the balance between upcoming corporate debt refinancing requirements and reinvestment in projects intended to drive future growth. In plain words, we are tactically adding to companies with stable cash flows and decreased debt loads outside of the mega-cap group. In Canada, we expect a modest earnings growth and remain attentive to how efficiently a corporation generates profits relative to their financing cost. We caution against the overly optimistic, commodity driven, “catch-up” trade vs. our southern neighbour. Therefore, we tweaked our investment strategy by rotating out of the low volatility factor and adding to higher yielding quality companies in Canada.
    

   Downloadable Copy

    

   Mark Warywoda, CFA VP, Public Portfolio Management	Ian Whiteside, CFA, MBA AVP, Public Portfolio Management	Johanna Shaw, CFA Director, Portfolio Management	Jin Li Director, Equity Portfolio Management
   Tyler Farrow, CFA Senior Analyst, Equity	Andrew Vermeer Senior Analyst, Credit	Elizabeth Ayodele Analyst, Credit	Francie Chen Analyst, Rates

    
   ADVISOR USE ONLY
   
   
   Any statements contained herein that are not based on historical fact are forward-looking statements. Any forward-looking statements represent the portfolio manager’s best judgment as of the present date as to what may occur in the future. However, forward-looking statements are subject to many risks, uncertainties, and assumptions, and are based on the portfolio manager’s present opinions and views. For this reason, the actual outcome of the events or results predicted may differ materially from what is expressed. Furthermore, the portfolio manager’s views, opinions or assumptions may subsequently change based on previously unknown information, or for other reasons. Equitable^® assumes no obligation to update any forward-looking information contained herein. The reader is cautioned to consider these and other factors carefully and not to place undue reliance on forward-looking statements. Investments may increase or decrease in value and are invested at the risk of the investor. Investment values change frequently, and past performance does not guarantee future results. Professional advice should be sought before an investor embarks on any investment strategy.
    
    
2. [pdf] Homewood Health Employee and Family Assistance Program
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7. 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.

8. Equitable Life Group Benefits Bulletin – February 2022 In this issue:
   • Update: Alberta biosimilar coverage changes*
   • Preferred Biosimilar Program*
   • Responding to Quebec’s biosimilar policy*
   • Dental fee guide updates*
   • Reminder: Review manual allocations for HCSAs and/or TSAs*
   • Mental health resources for plan members*
   *Indicates content that will be shared with your clients

   Update: Alberta biosimilar coverage changes*
   Four originator biologics added to Alberta Biosimilar Initiative

   In 2022, Alberta’s provincial drug plan is adding four originator biologics to its Biosimilar Initiative. It has ended or will end provincial coverage of these drugs for some or all conditions, as follows:
   • Lovenox: Jan. 10, 2022
   • Humalog: Feb. 1, 2022
   • NovoRapid: April 1, 2022
   • Humira: May 1, 2022

   Patients 18 and over 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.
   
   How we are responding to protect our clients
   To help prevent this change from resulting in additional costs for our clients’ drug plans while still providing plan members with access to safe and effective medications, we will no longer cover these originator biologic drugs for plan members in Alberta.
   
   Effective May 1, 2022, claimants currently taking these drugs will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable Life plan.
   
   This is a continuation of the Alberta biosimilar switch program we launched last March, when the province first introduced its Biosimilar Initiative.
   
   Do my clients need to take any action?
   No action is required by plan sponsors. Plan members taking these targeted originator biologics will be contacted directly to allow them ample time to transition to a biosimilar. Any cost savings associated with the change will be factored in at renewal.
   
   Groups that opted out of the biologic coverage changes we made last March will automatically be opted out of these coverage changes, as well as any future changes to our Alberta biosimilar switch program. This means that their drug plans will continue to provide coverage to existing claimants for any originator biologics we stop covering as part of our biosimilar program.
   
   Advisors with clients who wish to opt out of our Alberta biosimilar program, or who previously opted out and want to opt back in, should speak to their Group Account Executive or myFlex Sales Manager.
   
   Communication to plan members
   We will be communicating these coverage changes with affected claimants in early March to allow them ample time to change their prescriptions and avoid any interruptions in their treatment or their coverage. Thus far, the transition to biosimilars, has been smooth and continues to be successful.
   
   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 also biologics. 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.

   Preferred Biosimilar Program*

   As part of our ongoing efforts to help ensure the sustainability of your clients’ drug plans, we continue to engage in strategic partnerships with pharmaceutical manufacturers. 
   
   We are pleased to announce a partnership to make Hyrimoz our preferred biosimilar for Humira. This partnership will generate additional savings for plan sponsors.
   
   Plan members will still have the choice to use Humira biosimilars other than Hyrimoz. However, in the absence of alternative sources of reimbursement, this may increase their out-of-pocket amount.
   
   The Preferred Biosimilar Program will take effect March 1, 2022 for all new claimants across Canada who start using a Humira biosimilar. It will take effect May 1 for existing claimants in Alberta who switch to a Humira biosimilar, to align with changes to the provincial plan.
   
   Questions?
   If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.

   Responding to Quebec’s biosimilar policy

   Last year, the Quebec government announced it is phasing out coverage of biologic drugs. Beginning April 13, 2022, patients in Quebec using originator biologics will be required to switch to the corresponding biosimilar covered on the province’s public plan in order to maintain coverage.
   
   The following populations are excepted from this new policy:
   • Pregnant women, who should be transitioned to biosimilars in the 12 months after childbirth.
   • Pediatric patients, who should be transitioned to biosimilars in the 12 months after their 18^th birthdays.
   • Patients who have experienced two or more therapeutic failures while being treated with a biologic drug for the same chronic disease.
   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.
   
   We are actively investigating the impact of this new policy on private drug plans in Quebec. We plan to implement further enhancements to our biosimilar programs in Quebec later this year to help prevent this change from resulting in additional costs for our clients’ drug plans. We will provide more details in the coming months.

   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 2022.*
   
   Dental fee guide increases over 2021*

   Province/Territory	Average Fee Increase
   Alberta	3.9%
   British Columbia	7.35%
   Manitoba	5.79%
   New Brunswick	5.9%
   Newfoundland and Labrador	5%
   Nova Scotia	7.05%
   Northwest Territories	3%
   Nunavut	3.1%
   Ontario	4.75%
   Prince Edward Island	4.75%
   Quebec	5%
   Saskatchewan	5.99%

   *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.
    

   Reminder: Review manual allocations for HCSAs and/or TSAs*

   If your client’s Health Care Spending Account (HCSA) and/or Taxable Spending Account (TSA) has manual allocations, they need to allocate these amounts to plan members each year. Please review all your plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year.
    
   If your clients have Plan Administrator update access on EquitableHealth.ca, they can update these amounts online by doing the following:
   • Select “View certificate”
   • Select “Health Care Spending Account” or “Taxable Spending Account”
   • Select “Update Allocation” in Task Center
   • Enter amount in “Revised Allocation Amount”
   • Override Reason – “Plan Administrator Request”
   • Select “Save”
   If your clients have Plan Administrator reporting access on EquitableHealth.ca, they can determine which plan members have a zero allocation by running the “HCSA Totals by Plan Member” report online by doing the following:
   • Select “Reports”
   • Select “New”
   • Select “Next”
   • Select “HCSA” or “TSA Totals by Plan Member”
   • Select “Next”
   • Enter end date of “12/31/2020”
   • Select “Next”
   • Select “Finish”
   • View “Report”
   To provide us with the amounts to be updated, please have your client contact our Group Benefits Administration Team at GroupBenefitsAdmin@equitable.ca.

   Mental health resources for plan members*

   As the COVID-19 pandemic continues to evolve, many Canadians are experiencing increased levels of stress, anxiety, and depression. Through our partnership with Homewood Health®, all of our clients and their plan members have access to a number of health and wellness resources designed to provide guidance and support. These resources include a number of webinars which discuss various COVID-19 and mental health-related topics. The webinars are pre-recorded so plan members can stream them at their convenience.
    
   Understanding the Impact of COVID-19 on Your Mental Health
   English webinar
   French webinar
    
   COVID-19: Loneliness & Isolation Fatigue - Self-Care Strategies 
   English webinar
   French webinar
    
   COVID-19: Dealing with Seasonal Affective Disorder
   English webinar
   French webinar
    
   Reducing Anxiety & Managing the Transition Back to the Classroom - for Teachers
   English webinar
   French webinar
    
   COVID-19: Specialized Mental Health Support for Health Care Professionals
   English webinar
   French webinar
    
   COVID-19: Supporting Children’s Mental Health
   English webinar
   French webinar
    
   Additional resources, including articles, tools, videos and podcasts, are available at Homeweb.ca/Equitable. Please encourage your clients to share these resources with their plan members.
    
9. Equitable Life Group Benefits Bulletin - October 2022

   Introducing new Gender Affirmation Coverage for group benefits plans

   Providing an inclusive benefits plan can play a critical role in fostering a workplace culture that welcomes diversity and helps employees thrive. While most provinces cover the cost of gender-affirming surgery, each person has unique needs. Some may require procedures that are not publicly covered.
   
   That’s why we’re pleased to introduce a new coverage option for gender affirmation surgical procedures that are not covered by provincial health plans. Gender Affirmation Coverage helps plan sponsors to close the gap where provincial health coverage ends. 

   Coverage details and eligibility

   Gender Affirmation Coverage can be added to any Equitable Life plan with an in-force Extended Health Care plan. It provides coverage for gender-affirming procedures that are not covered by provincial health plans. This might include tracheal (Adam’s apple) shaving and voice surgery. It will also cover some additional procedures to further align the plan member’s features to the transitioned gender, such as facial bone reduction and cheek augmentation. This makes a wider variety of gender-affirming surgeries accessible to plan members and helps minimize their out-of-pocket costs.
   
   Plan members are eligible for coverage with a diagnosis of gender dysphoria from a qualified health care professional. 

   Offering a more inclusive benefits plan

   The coverage provides one more way for your clients to offer more inclusive coverage and to offer holistic support to their plan members undergoing a gender transition. We have developed this coverage as a complement to our existing coverage options, including Health Care Spending Accounts (HCSAs), Taxable Spending Accounts (TSAs), Extended Health Care and drug coverage, and Employee and Family Assistance Programs, all of which can provide support to plan members undergoing gender affirmation.
   
   We regularly review our products to ensure that they’re meeting your clients’ needs, and we’re committed to offering products that support diversity, equity and inclusion.
   
   We also continue to review our forms, documents and processes to make them more inclusive. This includes reviewing our online plan member enrolment (OPME) tool to allow for more flexibility with the way plan members identify their gender. 

   Gender affirmation and mental well-being

   Gender affirmation procedures can lead to improved mental health outcomes for those with gender dysphoria, as most report an improvement in their quality of life following the procedures. Gender dysphoria may occur when a person’s assigned sex at birth does not match their identity, and people experiencing gender dysphoria typically report psychological and emotional distress, including symptoms of depression or anxiety. By offering coverage where provincial health coverage ends, your clients can support plan members as they seek procedures that align their body presentation with their self-identified gender.
    

   Advantages at a glance

   Advantages for plan members include:
   • Reimbursement for some procedures and expenses, leading to fewer out-of-pocket costs
   • May experience improved mental health outcomes after surgery
   Advantages for plan sponsors include:
   • A benefits plan that promotes a culture of diversity, equity and inclusion, which may build employee loyalty
   • Support for plan member mental health to help those with gender dysphoria thrive
   For more information about how Equitable Life benefits plans can support the needs of those seeking gender affirmation surgery view our resources: 
   • Guide to Gender Affirmation Procedures and Therapies
   • Gender Affirmation Coverage Overview
   You can also contact your Group Account Executive for more information. If you have clients with myFlex plans who are interested in Gender Affirmation Coverage, please contact your myFlex Sales Manager to determine eligibility. 
    

   The Benefits Canada 2022 Health Care Survey results are in!

   Equitable Life is proud to be a Platinum sponsor for The Benefits Canada 2022 Health Care Survey, Canada’s leading survey on workplace benefits plans. This year’s survey report highlights many fascinating insights across a wide variety of benefits topics, including:
   • A focus on mental health for both plan sponsors and plan members
   • The repercussions of the "shadow" pandemic due to health care delays 
   • Trends in plan members' overall perceptions of their health benefits plans
   • The types of benefits getting more attention from plan members
   • The role of remote work in plan member satisfaction
   By surveying plan members and plan sponsor representatives across Canada each year, Benefits Canada works with its Advisory Board to provide timely insights on the employee benefits issues that are most important to Canadians. This year, our Group Vice-President of Western Sales, Meghan Vallis, has provided her expertise as an Advisory Board member.
   
   We’re committed to helping you and your clients navigate the evolving landscape of employee benefits in Canada by contributing to this vibrant industry community. To read the full report, visit Benefits Canada.
    

   HCSA and TSA manual allocation reminder

   If your clients’ Health Care Spending Account (HCSA) and/or Taxable Spending Account (TSA) have manual allocations, they need to allocate these amounts to plan members each year. Clients should review their plan members’ profiles on EquitableHealth.ca to ensure they have received their allocation(s) for the current benefit year. Your clients may also order HCSA and TSA forfeiture reports on EquitableHealth.ca. 
    
   If your clients have Plan Administrator update access on EquitableHealth.ca, they can update these amounts online by doing the following:
   • Select View certificate
   • Select Health Care Spending Account or Taxable Spending Account
   • Select Update Allocation in Task Center
   • Enter amount in Revised Allocation Amount
   • Override Reason – Plan Administrator Request
   • Select Save
   If your clients have Plan Administrator reporting access on EquitableHealth.ca, they can determine which plan members have a zero allocation by running the HCSA Totals by Plan Member report online by doing the following:
   • Select Reports
   • Select New
   • Select Next
   • Select HCSA or TSA Totals by Plan Member
   • Select Next
   • Enter end date of 12/31/2022
   • Select Next
   • Select Finish
   • View Report
   To provide us with the amounts to be updated, please have your client contact our Group Benefits Administration Team at GroupBenefitsAdmin@equitable.ca.