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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
- 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
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
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
- 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
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Two options for supporting plan members during the pandemic
We know these are difficult times. In addition to concerns about their health and the health of their family, working Canadians are worried about their jobs and their finances. Fortunately, through our partnership with Homewood Health®, we have two options for employers to support their employees through this crisis.
Below is an overview to refer to when you're meeting with your clients. Or you can download this PDF version.
Homewood Online (Homeweb)
All Equitable Life® clients and their plan members have access to Homeweb, a personalized online mental health and wellness portal. Accessible via the web or mobile app, Homeweb includes an online library of interactive tools, assessments, e-courses and resources to support plan members through the pandemic.
Homewood Health Employee and Family Assistance Program (EFAP)
Employers can provide additional support by adding the Homewood Health EFAP. In addition to full access to Homeweb, it offers confidential short-term counselling through a national network of mental health professionals, plus other resources and tools.
To make it easier to understand the options, here’s a detailed summary of what’s included with each:
Service Description Homeweb EFAP Homeweb.ca A secure and personalized online portal that includes hundreds of articles and resources, including e-books, toolkits, self-assessments, podcasts and more. Homeweb Mobile App One of Canada’s newest EFAP mobile apps that allows users to access every one of Homewood’s online tools and resources wherever they are. i-Volve Cognitive Behavioural Therapy Tool An online self-directed treatment tool that helps coach plan members to identify, challenge and overcome anxious thoughts, behaviours and emotions. Online Health Risk Assessment An online tool that helps plan members identify and address their health and wellness risks and barriers. Short-Term Counselling Short-term counselling provided face-to-face, by phone, email, chat or video through a national network of counsellors and clinical professionals. Life Smart Coaching A suite of telephonic and online services including coaching and resources to help employees manage their life balance, finances, health and career. Online resources only. Trauma response Prompt, compassionate and effective response to traumatic events, consisting of one three-hour block with one counsellor at one location per year. Legal Resources One-on-one consultation with a lawyer for guidance on issues such as family law, civil litigation, real estate and immigration. Online resources only. Key Person Advice Line (KPAL) Designed for HR, managers and supervisors, this service provides Online Management Resources and Workplace Situation Professional Support. Resource Locator Online childcare and eldercare resources locators. For more information, please contact your Group Account Executive or myFlex Sales Manager.
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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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Changes to the PMPRB
Earlier this month, the Government of Canada announced the final amendments to the Patented Medicines Regulations. These changes will impact how the Patented Medicine Review Board (PMPRB) sets the ceiling price for patented drugs and evaluates if the price of a drug reflects the value it has for patients. The intent of these updates is to enable the PMPRB to more effectively protect Canadians from excessive patented drug prices.
These changes do not come into effect until July 1, 2020. Finalizing the guidelines and consultation with stakeholders will occur leading up to this date. It is yet to be determined which drugs will be included in the final guidelines. It is anticipated the guidelines will initially focus on drugs launched shortly prior to and after July 1, 2020.
Equitable Life supports the modernization of the PMPRB and the ongoing need to evolve drug plan management tools in order to support the health of Canadians and drug plan affordability for public and private payers.
If you have any questions, please contact your Group Account Executive.
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Do you have clients looking for growth but are concerned about taking on too much risk?
Please join us to hear Dina DeGeer, Senior Vice President, Portfolio Manager, Head of the Mackenzie Bluewater Team and David Arpin, Senior Vice President and Portfolio Manager, Mackenzie Investments, discuss how the Mackenzie Bluewater Team is positioning the Mackenzie Canadian Growth Balanced Fund for future success
Learn about the value of investing in high-quality businesses and how taking a broader approach to fixed income investing can deliver the balanced solution your clients are looking for
Equitable Life is pleased to offer the Mackenzie Canadian Growth Balanced fund as one of six different Mackenzie funds in Pivotal Select™ segregated fund lineup.
Learn More
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Important update regarding all paramedical appointments
Update regarding parameds for NEW and EXISTING cases:
- In the absence of Parameds, the preferred method is to complete the medical questions in EZComplete
- If you didn’t complete the new medical information, then complete the Health Information Form #1878
- If you are unable to complete the 1878 Health Information Form, then you can order a Video EPara through Dynacare or through Equitable
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Equitable Life has made the decision to temporarily stop all face-to-face field service appointments effective immediately to ensure the protection of both our Clients and Examiners. All appointments will be cancelled by ExamOne. Dynacare has already cancelled their appointments.
We are doing this to support social distancing as requested by the Federal and Provincial governments. We are actively working on a plan to provide viable options in the absence of face-to-face paramedical service appointments. This will be communicated shortly.