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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. - Individual Insurance
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Equitable Life Group Benefits Bulletin – March 2022
In this issue:
- CLHIA launches industry anti-fraud initiative*
- Provincial biosimilar update*
- Quebec decreasing insurance premium tax*
- Coming soon: A survey to understand how we can better serve your clients’ needs*
- Remind your clients’ plan members in BC, Manitoba and Saskatchewan to register for Pharmacare *
CLHIA launches industry anti-fraud initiative*
In February, the Canadian Life and Health Insurance Association (CLHIA) announced a new anti-fraud initiative that is using advanced artificial intelligence (AI) to further identify and reduce benefits fraud.
Equitable Life is excited to be a part of this important initiative. It will enhance our own fraud detection analytics by using AI to connect the dots across a huge pool of anonymized claims data. This will lead to more investigations and actions to mitigate the impact of fraud on your clients’ plans.
The initiative is being led by the CLHIA and member insurers and is supported by technology provider Shift Technologies. It will be further rolled-out and expanded over the next three years.
Benefits fraud affects more than just insurers. The costs of fraud are felt by employers and their employees as well. We are looking forward to being able to better identify and reduce benefits fraud.
Provincial biosimilar update*
BC expands its biosimilar initiative
BC Pharmacare recently announced it is adding two rapid-acting insulins to the list of drugs included in its ongoing initiative to switch patients to biosimilar versions of high-cost biologics. Patients taking Humalog or NovoRapid for Type 1 or Type 2 diabetes will be required to switch to a biosimilar version of the drugs by May 29, 2022 to maintain coverage under the public plan.
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 biologic drugs they are based on, and Health Canada considers them to be equally safe and effective for approved conditions.
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 Humalog or NovoRapid for plan members in BC. Effective June 1, 2022, claimants currently taking Humalog or NovoRapid will be required to switch to a biosimilar version of the drugs to maintain coverage under their Equitable Life plan and their BC Pharmacare plan.
We will be communicating this change to plan administrators later this week. And we will be communicating with affected claimants in early April to allow 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.
Nova Scotia and Northwest Territories introduce biosimilar initiatives
The governments of Nova Scotia and the Northwest Territories each recently announced they are launching biosimilar initiatives to switch patients from certain originator biologic drugs to biosimilar versions of the drugs.
Patients in Nova Scotia using affected originator biologic drugs will have until February 2023 to switch to a biosimilar version of their medications in order to maintain coverage under the province’s public drug plans. Patients in the Northwest Territories will have until June 20, 2022, to switch.
Equitable Life® actively monitors and investigates all biosimilar policy changes and the ongoing evolution of biosimilar drugs entering Canada. We will keep you informed of any impact on private drug plans and how we are responding.
Quebec decreasing insurance premium tax*
The Quebec Government has announced that it plans to decrease its Insurance Premium Tax rates effective April 1, 2022. The premium tax rates for group life and accident and sickness insurance are expected to decrease from 3.48% to 3.3%. The new tax rates will be applied to premiums for the billing period beginning on or after April 1, 2022.
Coming soon: A survey to understand how we can better serve your clients’ needs*
We are committed to providing your clients and their plan members with industry-leading service. We’ve introduced several enhancements over the past year to make it easier to do business with us. And we’re continually looking for ways to improve.
In the coming weeks, we will conduct a survey of your clients to help us understand how we can better serve them. On March 28, we will send plan administrators an email with a link to the survey. The survey will remain open until the end of the day on April 11 and will take between five and 10 minutes to complete. Please encourage your clients to participate. Their feedback will be confidential, and their responses will help us improve our service and ensure we’re meeting their expectations. We may also follow up with plan administrators directly to address any concerns they’ve identified.
We know your clients’ time is valuable. So, each plan administrator who completes the survey will be entered into a random draw for a chance to win one of 25 prepaid gift cards for $25.
Remind your clients’ plan members in BC, Manitoba and Saskatchewan to register for Pharmacare*
If your clients have plan members in British Columbia, Manitoba or Saskatchewan, the provincial government offers a Pharmacare program to support prescription drug costs. Plan members in these provinces must register for their provincial Pharmacare program to maintain coverage under their Equitable Life drug plan.
Registration is easy! We will send two registration reminder messages directly to plan members’ pharmacists and post them on their Explanation of Benefits. We’ve also created a step-by-step guide that your clients can share with their plan members.
English version
French version
For more information about the provincial Pharmacare programs, including how plan members can register, please visit:
For British Columbia residents: https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents
For Manitoba residents: https://www.gov.mb.ca/health/pharmacare/apply.html
For Saskatchewan residents: https://www.saskatchewan.ca/residents/health/prescription-drug-plans-and-health-coverage/extended-benefits-and%20drug-plan/drug-cost-assistance#eligibility
- [pdf] Limited Trading Authorization
- [pdf] Asset Rebalancing - Equitable GIF
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Supporting you and your group clients during the COVID-19 pandemic
We know these are challenging times.
As COVID-19 continues to spread, we want to reassure you that we remain ready and committed to support you, your group clients and their plan members.
We have a robust and well-tested business continuity plan in place and have taken the necessary steps to maintain the high level of service you have come to expect from us. Our business is near 100% digital, so the vast majority of our employees are now working remotely from home and are fully functional. Our Customer Care Centre remains open to support plan members and can be reached at 1.800.265.4556. And our Client Relationship Specialists are available for Plan Administrator questions and support.
As the situation continues to develop, we know you will have questions about what it means for your clients and their plan members. We have already issued announcements related to Travel Assist coverage for plan members who are outside of the country, and about short-term disability coverage for plan members who are in quarantine or self-isolation. We will continue to provide timely updates as developments unfold.
All of us are facing an unprecedented number of urgent situations where there is no established protocol. Our commitment to you and your clients is to respond quickly, and to be flexible where we can, tailoring solutions to specific needs. The global situation is evolving rapidly; we ask for your patience as our solutions also evolve quickly and accordingly. Your Group Account Executive and myFlex Sales Manager are well equipped to navigate Equitable Life’s experts and to resolve difficulties.
These are extraordinary times and history is in the making. Rest assured that Equitable Life is unwavering in our support, and we will be here to help you when it matters most.
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Update on our service levels during the COVID-19 pandemic
Supporting your clients and their plan members is more important than ever during the ongoing COVID-19 pandemic
So, we’re providing an update on our service levels.
We acted quickly to ensure there were no disruptions in service – most of our staff were working remotely from home and fully functional within a few days. We’ve reallocated resources from functions where volumes are down, such as dental claims, to those experiencing higher volumes. We also created a separate queue for COVID-19-related STD claims.
As a result, we’ve been able to maintain the industry-leading service levels you have come to expect from us, and our turnaround times continue to be well within our targets.
Here’s a summary of what you and your clients can currently expect in terms of average turnaround times:
Service category Average Turnaround Time
(as of April 26th)Customer Care Centre wait times 89% of calls answered within 20 seconds Responses to emails to our Service Team Within 24 hours Health claims 2 days Dental claims 2 days Life claims 1 day STD claims 4 days LTD claims 4 days Plan member updates 2 days New customer implementations 16 days COVID-19-related plan amendments 4 days Other plan amendments 8 days Quotes 2 days ahead of deadline We will closely monitor the situation and continue to adapt to ensure we maintain our service levels. And we will do our best to resolve any service issues that arise as quickly as possible.
Please feel free to contact your Group Account Executive or myFlex Sales Manager and let us know how we’re doing.
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Anti-money laundering legislation changes
To comply with the Government of Canada’s anti-money laundering legislation and FATCA/CRS changes, Equitable Life® has made changes to the information that we collect on some of our applications and forms.
Changes and updates to our online forms and applications include the following:
● The 350 Application for Life Insurance - Advisors can order new paper applications from Equitable’s Supply Team by filling out the Supply Order form 1390 and emailing it to supply@equitable.ca. You will receive your copies as they become available.
◦ Paper applications submitted after May 15, 2021, with a version date before April 2, 2021 will be accepted with the caveat that additional information may be required from the advisor to comply with anti-money laundering legislation.
◦ As of July 1, 2021 any application with a version date prior to April 2, 2021 will no longer be accepted by Equitable Life.
● Equitable’s EZcomplete® online application reflects the new changes effective May 15, 2021. Any in-flight applications in EZcomplete will automatically be updated to comply with anti-money laundering legislation. You may be required to complete additional fields before submitting the application for signatures.
● Various other forms will now require additional information. A complete list of all forms and applications affected by the anti-money laundering legislation can be found here.
Learn more about the Government of Canada’s anti-money laundering legislation and Financial Transactions and Reports Analysis Centre of Canada -
Deposits to the Fidelity Special Situations mutual fund are being limited but the segregated fund is
Fidelity Investments® recently said they would no longer accept deposits from new investors into the Fidelity® Special Situations Fund. This notice however does not affect Equitable Life® clients.
The Special Situations Fund will continue to be open to new and existing Equitable Life clients. This includes clients with Pivotal Select™, Pivotal Solutions* or Personal Investment Portfolio segregated funds contracts.
Why is Fidelity limiting access to the mutual fund?
This award-winning mutual fund has grown significantly and now has $3.6 billion of managed assets. To preserve the integrity of the fund’s investment strategy, Fidelity® decided to limit inflows to the fund. Limiting the amount of managed assets held within the fund allows the fund’s portfolio manager to focus on what he does best - finding special situation investment opportunities and capitalizing on positive change within companies and industries across Canada and around the world.
If you like the Special Situations mutual fund, you will value the Equitable Life Fidelity® Special Situations segregated fund. Segregated funds are similar to mutual funds but offer different features and guarantees. To learn about these features, check out the Investment Advantage. To learn more about the Special Situations segregated fund, click here.
For more information about Equitable Life’s segregated funds, speak to your Regional Investment Sales Manager or visit our segregated funds page on EquiNet®.
References:
Fidelity’s press release announcing the limited fund closure
Fidelity® Special Situations portfolio management strategy, webinar featuring Mark Schmehl, Portfolio Manager.
*No Load, Deferred Sales Charge, Pivotal Solutions II
® or ™ denotes a trademark of The Equitable Life Insurance Company of Canada, except as noted below.
Fidelity and Fidelity Investments are registered trademarks of 483A Bay Street Holdings LP. Used with permission.