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April 2023 eNews
Vision care discounts from Bailey Nelson for Equitable Life plan members*
We are pleased to announce we are partnering with Bailey Nelson to provide Equitable Life plan members with discounts on prescription and non-prescription eyewear. Bailey Nelson is a leading provider of prescription glasses, contact lenses and sunglasses with locations across Canada, as well as an online store.
All Equitable Life plan members will have access to the following discounts from Bailey Nelson:
*Includes anti-reflection and anti-scratch treatment. Glasses offers are based on 2 pairs of single vision or 1 pair of premium progressive lenses. Lens add-ons, such as high-index lenses and prescription tinted lens tints may involve additional costs.
**Non-prescription glasses only. Cannot be combined with 2 for $200 discount.
Plan members can provide their Equitable Life discount code in-store or at online checkout. Your clients may wish to distribute this convenient flyer with an overview of the available discounts to their plan members.
Plan members can bring their prescription to a Bailey Nelson location or provide it online to order glasses and contact lenses. Bailey Nelson also provides eye exams in-store for $99.
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager.
Equitable Life helps tackle benefits fraud through Joint Provider Fraud Investigation (JPFI) initiative*
Protecting your clients’ plans is important to us. That’s why Equitable Life is working with other Canadian life and health insurers to conduct joint investigations into health service providers that are suspected of fraudulent activities through the Canadian Life and Health Insurance Association’s (CLHIA’s) Joint Provider Fraud Investigation (JPFI) initiative. This collaborative initiative between major Canadian life and health insurers through the CLHIA is a major step toward reducing benefits fraud in the life and health benefits insurance industry.How the JPFI works
The JPFI builds on the 2022 launch of a CLHIA-supported industry program. The program uses advanced artificial intelligence to help identify fraudulent activity across an industry pool of anonymized claims data. Joint investigations will examine suspicious patterns across this data.
Through this project, Equitable Life can initiate a request to begin a joint fraud investigation when we:- See suspected provider fraud in our own data or the pooled data, or
- Receive a substantiated tip about potential provider fraud
How Equitable Life protects your clients’ benefits plans from fraud
Benefits fraud is a crime that affects insurers, employers and employees and puts the sustainability of workplace benefits at risk. CLHIA estimates that employers and insurers lose millions each year to benefits fraud and abuse.
Our Investigative Claims Unit (ICU) consists of security and fraud experts who use data analytics and artificial intelligence to proactively identify and investigate suspicious billing patterns or claims activity to open investigations. We de-list healthcare providers who are engaged in questionable or fraudulent practices, pursue the recovery of improperly obtained funds, and report practitioners to regulatory bodies and law enforcement where appropriate.
Learn more about benefits fraud, or contact your Group Account Executive or myFlex Sales Manager for more information.Second phase of TELUS eClaims transition*
In June 2022, we switched to TELUS Health eClaims as our digital billing provider to give our plan members a faster and more convenient option for submitting paramedical and vision claims. The switch has allowed our plan members to take advantage of TELUS’s extensive network of over 70,000 paramedical and vision providers.
We’ve now begun the second phase of our TELUS Health eClaims implementation. This phase will focus on improving the experience for paramedical and vision providers. We will begin issuing reconciliation statements for the claims they submit on behalf of their patients. These statements will make it easier for them to use the TELUS Health eClaims portal and provide incentive for even more providers to sign up.
Please encourage your clients to remind their plan members about this convenient option. We have created a helpful one-pager that plan members can bring with them next time they have an appointment with their healthcare provider.
If you have any questions about TELUS Health eClaims, please contact your Group Account Executive or myFlex Sales Manager.
Changes to STD application process for COVID-19 cases*
As the COVID-19 situation evolves, we continue to adjust our disability management practices to ensure ongoing support and a fair experience for all our plan members.
As of May 1, 2023, we will begin managing COVID-19-related short-term disability (STD) claims the same way that we manage disability claims for any other illness or condition. If a plan member is unable to work due to COVID-19 symptoms or a positive COVID-19 test, they must now use the standard STD application, including the Attending Physician Statement portion.
Once we receive the claim, we will adjudicate it according to our standard process.
If you have any questions, please contact your Group Account Executive or myFlex Sales Manager.
* Indicates content that will be shared with your clients.
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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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Our Critical Illness Insurance Path to Success Program
Our Critical Illness Insurance Path to Success program was designed with you, the Advisor, in mind.
Path to Success: Expert Advice on navigating CI Sales provides you with actionable ideas and scripts that you can implement immediately into your critical illness insurance meetings. CE Credits are available if you review the program in its entirety and complete the quizzes at the end of each section.
Learn more about the CI Path to Success Program
Next steps:
If you have any questions or are interested in getting access to this program, please reach out to your Regional Sales Manager directly.
Enhancements to our Critical Illness Insurance product EquiLiving®
The timing couldn’t be better for connecting with your Regional Sales Manager to gain access to this program, as we have made recent enhancements to our Critical Illness product that will help you offer more options to clients. We’ve enhanced our EquiLiving plans and riders with:
• 20 pay options with coverage to age 75 or coverage for life
• Support from Cloud DX to help monitor a client’s well-being from treatment to recovery
• Added Acquired Brain Injury as a covered critical condition
• 30-day survival period removed for all non-cardiovascular covered conditions
• No age restriction to claim for Loss of Independent Existence (LOIE)
• Adult Covered Conditions definitions updated to 2018 CLHIA definitions
• Increased the number of Early Detection Benefit covered conditions from 4 to 8
• And so much more …
Contact your Regional Sales Manager to get set up in the program and learn about other CE accredited presentations happening each week. - Investment loans
- Investment loans
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April 2024 eNews
In this issue:
- Competitive – and easy – benefits plans for your small business clients
- Simplifying benefits enrolment for your clients*
- NEW time-off tracking tool from HRdownloads*
- Focus on benefits fraud: Protecting your clients’ plans from abuse*
Competitive – and easy – benefits plans for your small business clients
Supporting your small business clients can be a challenge. It’s tough to find a competitively-priced benefits plan with the features they want. Small business owners may also need more of your time – especially if this is their first benefits plan.
That’s why we created Equitable EZBenefits™, a benefits solution designed with the needs of small businesses in mind. With a range of plan design options and valuable embedded services for plan sponsors and plan members, EZBenefits is available for groups with 2 to 25 employees. And to make things simpler for you, we’ve created an Advisor Concierge Service exclusively for EZBenefits. Whether you have a question about submitting a quote request for a new client or an issue with an in-force client, our Concierge Service is your go-to resource for EZBenefits support.Don’t have any EZBenefits clients yet?
To learn more about EZBenefits, watch our video to learn more or view our brochure.Simplifying benefits enrolment for your clients*
Navigating the benefits enrolment period can be overwhelming – for you, your clients and their employees. It’s difficult to ensure all plan members complete the necessary paperwork before the enrolment deadline.
That’s why we offer our secure Online Plan Member Enrolment tool at no extra cost to plan sponsors. The tool simplifies the onboarding process for your clients and their plan members by eliminating the need for paper enrolment forms.
It also makes enrolment faster and easier for your clients by:- Reducing errors and rework that can occur due to spelling mistakes or missing information on paper forms; and
- Sending automatic enrolment reminders to plan members, resulting in fewer late applicants.
- Enrol in their benefits plan in just minutes from their computer or mobile device;
- Easily enter all their enrolment information, including dependent details, banking information for direct deposit of claim payments and details for coordination of benefits; and
- Designate their beneficiary electronically.
Ready to share our Online Plan Enrolment Tool with your clients? Get them started with these helpful resources:
- Online Plan Member Enrolment Flyer for Plan Administrators
- Online Plan Member Enrolment Quick Reference Guide for Plan Administrators
- Quick Reference Guide for Plan Members
To learn more about how Online Plan Member Enrolment can simplify benefits enrolment for your clients, contact your Group Account Executive or myFlex Account Executive.
NEW time-off tracking tool from HRdownloads*
Through our partnership with HRdownloads®, EZBenefits clients now have complimentary access to Timetastic —a time-off tracking tool that can make it easier to manage employee vacation time, sick days and more.
Timetastic integrates seamlessly with HRdownloads and includes a mobile app to help manage time-off requests from any mobile device.
To see Timetastic in action, check out this demo.
EZBenefits also includes other helpful resources and tools from HRdownloads that can make daily human resources tasks easier, including:- A robust, award-winning HR management platform (HRIS);
- HR documents, templates, compliance resources and articles; and
- A live HR advice helpline.
Learn more about accessing HRdownloads.Focus on benefits fraud: protecting your clients’ plans from abuse*
According to the Canadian Life and Health Insurance Association (CLHIA), benefits fraud costs insurers and plan sponsors millions of dollars each year, which can lead to increased premium costs.
Resources for your clients
Both plan administrators and plan members play a role in preventing benefits abuse. So, we’ve compiled some resources you can share with your clients to help them understand what benefits fraud is and how to prevent it:- CLHIA’s free 15-minute Protect Your Benefits online course for plan administrators and their members
- CLHIA’s Fraud is Fraud program, including their FAQs on benefits fraud
- Our online guide to benefits abuse
- Tips for plan administrators and plan members to protect their plan
How we’re fighting benefits fraud
Our Investigative Claims Unit (ICU) works to detect and eliminate benefits fraud. We use a variety of investigative techniques, including CLHIA-led industry tools to detect and eliminate benefits fraud:- Joint Provider Fraud Investigation Program: A robust program that allows insurers to collaborate on fraud investigations that affect multiple insurers;
- Data Pooling Program: An initiative that pools data between insurers and uses advanced artificial intelligence to further identify and reduce benefits fraud; and
- Provider Alert Registry: A registry that allows insurers to view the results of other insurers’ anti-fraud investigations into specific practitioners.
- [pdf] Equitable HealthConnector
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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.