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October 2019 Advisor eNews
Coverage of Remicade, Enbrel and Lantus in BC
As we announced in August, BC PharmaCare recently introduced a new Biosimilars Initiative that ends coverage of three biologic drugs, including Remicade, Enbrel, and Lantus. These drugs will no longer be eligible in British Columbia for most conditions for which lower-cost biosimilar versions are available. Patients in the province with these conditions will be required to switch to biosimilar versions of these drugs by Nov. 25, 2019 in order to maintain their coverage under BC PharmaCare. Patients taking Remicade for Crohn's Disease or Ulcerative Colitis will not be required to switch to a biosimilar until March 6, 2020.
Biologics are drugs that are engineered using living organisms, such as yeast and bacteria. Biosimilars are highly similar to the originator drugs they are based on and most have been shown to have no clinically meaningful differences in safety or efficacy.
To ensure this provincial change doesn’t result in your clients’ plans paying additional drug costs, we have aligned our drug eligibility for these three biologic drugs with that of BC PharmaCare.
As previously announced, effective Nov. 25, 2019, Remicade and Enbrel will no longer be eligible for BC plan members with conditions for which lower-cost biosimilar versions of the drugs are available. These plan members will be required to switch to the biosimilar versions of these drugs in order to maintain eligibility on the Equitable Life drug plan. We have communicated with Plan Administrators about this change, and we have informed affected claimants of the need to switch medications.
As well, effective Feb. 3, 2020, the drug ingredient cost for Lantus will no longer be eligible for BC plan members; only the dispensing fee may be eligible under their Equitable Life plan. Plan members taking Lantus will be required to switch to Basaglar, the lower-cost biosimilar version of the drug, in order to maintain coverage under their Equitable Life plan. We will be communicating with Lantus claimants in the coming weeks to allow them ample time to change their prescription 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 Sales Manager.De-listed service providers
As part of our ongoing initiative to have Group Benefits plans only reimburse eligible claims, we conduct reviews of the billing and administrative practices of service providers, including clinics, facilities and medical suppliers.As a result of these reviews we may de-list certain providers. We will no longer accept, or process claims for services and/or supplies obtained from those providers. The plan member can still choose to obtain services or supplies from these providers, but Equitable Life will not provide reimbursement for the claims.
Review Equitable Life’s de-listed service providers
The delisted service provider list is also posted on EquitableHealth.ca for plan members to review to determine if their claim(s) are eligible for reimbursement under their Group Benefits plan.
For more information about protecting group benefits plans from abuse, check out our articles.
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Equitable Life Coronavirus Update – March 13, 2020
As the coronavirus (COVID-19) continues to spread, it’s important that you, your clients and their plan members have the most up-to-date information. We are providing timely updates on any developments that impact your clients and their plan members or their benefits coverage.
Please share this information with your clients. You can direct them to EquitableHealth.ca, where we have posted a version of these updates.
Coronavirus travel coverage*
For groups with Travel Assist coverage
The Public Health Agency of Canada has issued several Travel Health Notices advising Canadians to avoid travel to countries and regions where there have been outbreaks of coronavirus (COVID-19).
A good resource to help your clients and their plan members understand how the spread of the coronavirus may impact their travel plans is the Public Health Agency of Canada’s Coronavirus Travel Advice site. The levels of risk by country and region are regularly updated.
If your clients’ plan members cannot avoid travelling, Public Health recommends they take steps to prevent illness and seek medical attention if they become sick.
Where to find the latest information
The list and level of travel advisories can change at any time. Please check the Government of Canada’s Travel Advisor and Advisory page for the most current information.
If your clients’ plan members have coronavirus symptoms while travelling, please advise them to contact Travel Assist at the numbers listed below for assistance.
Advise plan members to call before they travel
If a plan member is travelling anywhere outside of the province or country and their benefits plan includes Travel Assist, plan administrators should advise them to make sure they’re prepared for a medical emergency by following these steps.
- Check the Government of Canada’s Travel Advisor and Advisory page. Note that it is important to click on the country to check whether any specific regions of that country have travel advisories.
- If they have questions, they should call Travel Assist before they travel for assistance and benefit information.
- Pack their Equitable Life benefits card and provincial health card.
- In a medical emergency, call the Travel Assist 24-Hour Hotline:
- Toll-free Canada/USA: 1.800.321/9998
- Global call collect: 519.742.3287
- Allianz Global Assistance ID #9089
Allianz Global Assistance administers Equitable Life’s Travel Assist benefits. Allianz has an international network of medical facilities, transportation providers, medical correspondents and multilingual administrative agents who aid with medical, legal and most travel-related emergencies 24-hours a day, seven days a week.
Early prescription refills and drug shortages*
In response to concerns about COVID-19 TELUS Health, our pharmacy benefits manager, has announced it is maintaining its standard rules for refills of medication. Plan members can refill their medications when at least two-thirds of the last dispensed supply has been used.
If plan members need more than the maximum supply allowed on their plan, they must pay out-of-pocket for the excess amount. They can then submit a claim to ask for an exception request.
TELUS is taking this position to help maintain access to medication for all patients. They continue to monitor the situation. We will provide an update if it changes.
Drug shortages
TELUS Health monitors for drug shortages and updates their system for any unavailable drugs. This helps to ensure accurate claims payment. If a referenced lowest-cost generic drug is unavailable, claims for drugs in the class will be paid at the next lowest-cost generic alternative available.
*Indicates content that will be shared with your clients
- [pdf] Equitable Life Dynamic US Monthly Income Fund Select
- [pdf] B2B Loan application process for Equitable Life of Canada
- WFG Life Business Month End Cycle - Cut Off Schedule
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Anti-money laundering legislation changes for Savings & Retirement forms and applications
To comply with the Government of Canada’s anti-money laundering legislation and FATCA/CRS changes, Equitable Life® has updated its Savings and Retirement forms and applications. New online forms and applications are available to download from EquiNet®. Paper applications are also available to order from Equitable’s Supply Team. For a complete list of all forms and applications affected by the anti-money laundering legislation, refer to Anti-money Laundering Legislation Requirements Summary.
What should I do if I have existing paper applications?
If you currently have paper applications (Form #1383, #1384, #799, #355) with a version date that is before April 2, 2021, Equitable Life will continue to accept them, with the caveat that additional information may be required from you and your client to comply with anti-money laundering legislation.
How long can I use my existing paper applications with a version date before April 2, 2021?
Paper applications (Form #1383, #1384, #799, #355) with a version date prior to 2021/04/02 (located on the back page and in the bottom right-hand corner of the application) will no longer be accepted after July 1, 2021. If you have applications with a date that is before 2021/04/02, please destroy them and use the fillable/savable PDF on EquiNet. You can also order paper applications from our Supply Team.
Want to be sure you always have the most up-to-date application? Try our EZcomplete® online application platform. EZcomplete makes it easy to process your non face-to-face applications and allows your clients to provide their signature remotely on their own device.
To learn more about the Government of Canada’s anti-money laundering legislation and FATCA/CRS review the following links.
Government of Canada - Guidance on the Common Reporting Standard
Financial Transactions and Reports Analysis Centre of Canada
If you have any other questions, contact your Regional Investment Sales Manager.
® denotes a registered trademark of The Equitable Life Insurance Company of Canada.
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Dialogue Virtual Healthcare now available to add to Equitable Life benefits plans
We’re pleased to announce we are partnering with Dialogue, Canada’s leading virtual health provider, to offer unlimited and on-demand virtual access to primary healthcare practitioners.
Virtual Healthcare is the latest addition to our HealthConnector suite of health and wellness services. It is available to add to all Equitable Life benefits plans for an additional cost as of July 1, 2023.Features of Dialogue Virtual Healthcare
Available 24/7, 365 days a year, Dialogue Virtual Healthcare provides access to unlimited non-urgent medical care for a wide range of health concerns. Plan members get fast access to the largest, most experienced and bilingual medical team in Canada for non-urgent medical issues. They also benefit from in-app prescription renewals and refills, personalized follow-ups after every consultation, and concierge-level navigation support for all referrals to in-person specialists when needed.
Dialogue’s industry-leading platform provides an all-in-one patient journey to address health issues, reducing long wait times and time away for doctor appointments. Plan members and their families can access Dialogue Virtual Healthcare through the secure web portal or mobile app. The Dialogue medical team includes doctors, nurse practitioners and nurses. Plan members can use the service even if they’re already receiving care from a family doctor.
For your clients
Benefits of Virtual Healthcare
By providing access to Virtual Healthcare, plan sponsors can help to:-
Drive employee engagement;
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Reduce absenteeism related to in-person medical appointments;
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Manage chronic health issues;
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Attract and retain top talent; and
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Build a healthier workforce.
By providing easier access to primary healthcare practitioners, Virtual Healthcare can offer extra health and wellness support for plan members. It also supports members that may experience barriers to accessing in-person healthcare, such as:-
Living in a remote location;
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Work or family obligations during standard medical clinic hours;
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Mobility challenges related to a disability; and
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Transportation challenges.
Click the link to learn more about Dialogue Virtual Healthcare : Welcome to Dialogue!Questions?
To learn more about how your clients can add Virtual Healthcare to their benefits plan, please contact your Group Account Executive or myFlex Sales Manager. -