Employees are dealing with Chronic Disease

The 2019 Sanofi Canada health-care survey has reported that more than half of Canadian workers (54%) indicated they have at least one chronic disease or condition. Chronic disease is on the rise is a challenge for both employees and employers.

The most commonly reported issues were mental illness, hypertension, high cholesterol, arthritis and diabetes. Many (42 %) respondents also reported having chronic pain.

More older workers suffered from a chronic disease or condition than those under age 55.

82% of plan sponsors would like their benefit plan to do more to support employees dealing with chronic conditions. 89% of those with chronic pain would like information on ways to manage it.

Almost a third of members with chronic conditions said they take three or more medications regularly, compared to four percent of members without a condition.

Insurers are providing initiatives to help manage chronic diseases.

RBC Insurance offers group benefit members a wellness app, reduced pricing on drug compatibility testing and is piloting a “Manage my Pain” app as well.

Manulife is also pilot testing a pharmacogenetics program.

It is important that plan members are aware of these programs and take advantage of them when possible. This can help members manage their chronic conditions, reduce absenteeism and therefore lost productivity and help manage the cost of drugs.

2019 Sanofi Canada health-care survey

Provincial dental fee increases for 2019

Sun Life has provided the updated dental fee increases for 2019. Typically, there is an increase across the board for dental
services performed by general practitioners. The information in provincial fee guides
helps to establish reimbursement levels for the dental services plan members
This chart summarizes fee guide increases announced for 2019 by the provincial
dental associations.

2019 Dental Fee Update

Source: Sunlife.ca/focusupdate

Changes to Ontario’s labour legislation

There are changes to the Ontario government’s Employment Standards Act which was brought in January 2018 (Bill 148 the Fair Workplaces, Better Jobs Act, 2017 ). The new government which was elected in June 2018 has announced changes to the Employment Standards Act taking effect January 1 2019 under Bill 47 the Making Ontario Open for Business Act. Here are some of the new details:

Minimum Wage

The minimum wage was increased to $15 an hour under the previous Employment Standards Act. The general minimum wage will remain at $14 an hour through 2019 and then beginning 2020, annual minimum wage increases will be tied to the consumer price index.

Minimum on-call pay

There was to be a minimum on-call pay which is applicable when an employee is on-call, but is either not called into work or is required to work but for less than three hours, despite the employee being able to work longer. This change had not yet come into effect and has now been repealed by the new legislation.

Right to refuse work

Another section which has been repealed before it was to come into effect is the employee’s right to refuse a request or demand to work or to be on-call on a day they weren’t scheduled if this request is made less than 96 hours before the start of the shift.

Personal emergency leave

The new bill has replaced the previous standards regarding personal emergency leave. The new bill provides three new unpaid leaves of absence available to any Ontario employee regardless of the size of employer.

  • Sick leave up to three unpaid sick days per calendar year where an employee has been employed for two consecutive weeks. This is for the employee’s own personal illness, injury or medical emergency.
  • Family responsibility leave up to three unpaid days each calendar year. This is intended for illness, injury or medical emergency of a listed family member.
  • Bereavement leave up to two unpaid days each calendar year for bereavement leave. This is to be used for the death of a listed family member.
  • Equal pay for equal work

    The former bill expanded equal pay for equal work based on an employee’s employment status (for example permanent vs causal) or based on the number of hours they worked. This included differences in pay for employees placed by a temporary employment agency. The new bill has repealed these changes but continues to require equal pay for equal work on the basis of gender.

    Three hour rule

    The new bill modifies changes to the three hour rule which had not yet come into effect. The new rule applies to an employee who regularly works more than three hours a day who is required to present themselves to work but then works less than three hours despite being able to work longer. The employee would be entitled to be paid wages for three hours – the greater of two amounts:

  • three hours of pay at the employee’s regular rate, or
  • the sum of the amount of the employee earned while working and the remaining time calculated at the employee’s regular rate
  • This does not apply when the employer is unable to provide work due to power failure, fire or other similar causes beyond the employers control.

    Employee classification

    While there remains a prohibition against treating a worker who is truly an employee as someone who is not an employee (generally, an independent contractor), the “reverse onus” has been removed. That is, the onus will shift back to workers, who will be required to prove that they are in fact an employee.

    If an employer has updated their policies to reflect the changes to the employment standards act, the new changes does not automatically reverse these changes. For example if an employer had implemented pay increases to reflect the proposed increase to the minimum wage, a reduction in light of the minimum wage freeze could cause unhappiness among employees.

    It is important to review current policies to ensure compliance to the standards coming into effect.


    Osler -Back to 2017: New Ontario government revokes pre-election employment law changes

    Benefits Canada – A summary of Ontario’s changing employment and labour legislation

    Bennett Jones – Bill 47 Implements Significant Changes to Ontario Employment Standards Legislation

    Employment Standards – Ministry of Labour

    Virtual Health Care

    There is a growing interest in virtual health care. Employers are finding many of their staff do not have access to family doctors, or some staff may find it more convenient to access virtual health care options as opposed to accessing walk in clinics. Virtual health care is a method, or methods, by which physicians and other health care providers, such as nurses or medical assistants, communicate with patients without physically seeing them in the office. This could be via telephone or video via an app. Virtual visits enable patients to communicate with their health care team from wherever they are, and in a way convenient for both the patient and the provider.

    According to a survey by Medisys Health Group Inc., more than two-thirds of employee respondents said they would use the benefit if it were available to them. We are finding that virtual health care is indeed on the radar of many employers.

    Employees like the ability to access services during off hours and weekends as well as the ability to bypass legnthly hospital waits for minor health problems. Employers like less work time being missed for appointments and the prospect of healthier employees as people are less likely to put off making an appointment to see the doctor or go to a walk in clinic if they are able to access health services virtually. Virtual health would also benefit people living in rural areas by increasing their health care options.

    It is felt that some groups of employees (for example millennials or employees who are often travelling) would be more likely to use a virtual health care app.

    When it comes to widespread implementation of virtual health across the country, many experts say the timing has never been better to make virtual healthcare a reality for patients and caregivers.

    We are very pleased to offer our clients the benefit of our partnership with Advica Health. For more information, contact us.

    Source: Newswire.ca New study shows Canadian employees demanding virtual healthcare to bypass barriers to traditional care

    Manulife’s Life Moments supports plan members through critical life moments

    Manulife has created the Life Moments team to help plan members through critical life moments. Plan members have identified 18 moments in life that cause them the most financial and emotional stress. These life moments include:

    • Birth of a child
    • Child comes of age
    • Overage dependent
    • Joining of families
    • New job
    • Leaving a job
    • Marriage/partnership
    • Critical illness/ injury
    • Retirement
    • Receiving an inheritance
    • Life policy maturing
    • Buying your first home
    • Paying off your mortgage
    • Divorce
    • Death of a loved one
    • Bankruptcy
    • Transition to long term care
    • Living through a disaster or catastrophe

    What does this mean to plan members?

    No more having to call multiple numbers during these sometimes-difficult times. The Life Moments team, will serve as a single point of contact.

    18 life moments are a lot! So, Manulife has decided to tackle these one at a time, starting with the death of a loved one. When the Life Moments team gets a call to notify them of the passing of a plan member, they’ll run a search for other possible products the member might have with Manulife. Once they have all the information they need, they’ll coordinate all necessary notifications across the organization on behalf of the caller and get the claims process started. Having a single point of contact, is a step in the right direction to making this time as easy as possible for members.

    Over the next couple of months, Manulife will be rolling out help for members with with additional life moments.

    Source: Advance Hub

    Sun Life announces Lumino Health network

    Sun Life has launched the Lumino Health network (luminohealth.ca) – an online network of health resources to all Canadians.

    The Lumino Health network will help Canadians make better decisions about the providers, products and services that they use.
    This is a resource where Canadians can find all this health information at their fingertips, using accurate and trusted provider ratings, cost transparency.

    There are many situations where people may need help finding health care
    information or a new health-care provider. They could be dealing with a new health
    condition requiring specific treatment, they’ve moved to a new town, or their regular provider has retired.

    The information they need will now be available at their fingertips through Lumino Health.
    Sun Life’s relationships with health-care providers and innovators – along with millions of clients – provides them with a wealth of valuable data relating to health-care costs, claims, and provider locations and ratings.

    With Lumino Health, they use this data to provide Canadians with better choice, better access, and better value when it comes their health-care decisions.

    Features of Lumino

  • Search for top-rated health providers through Provider Search: Lumino
    Health makes the exclusive Provider Search tool available to everyone.
    Canadians can search from more than 150,000 health providers from across
    the country – supported by more than six million ratings from plan members
    who have used these services. Providers include dentists, massage therapists,
    chiropractors, physiotherapists, psychologists and more. In addition to
    identifying top-rated health providers, Canadians will be able to cost compare
    services and products to further refine their search. Many providers also offer
    additional information such as hours of service, areas of specialty, and
    languages spoken. Users can even request an appointment, right from within
    the tool.
  • Learn about new health solutions: Sun Life has researched and met with
    hundreds of health-care innovators who are looking to solve health pain
    points for consumers. They showcase their top innovation picks in Lumino
    Health’s Discovery lab, often with a discount or special offer. And they
    continue to update the lab with health innovations as they find them.
    The products and services offered are the ones Sun Life thinks have real potential
    to help Canadians live healthier lives. Consumers can also provide feedback
    and ratings on their experience with the health innovations they’ve tried
  • Gain health knowledge: Sun Life is partnering with organizations who have
    credible voices on health, such as Diabetes Canada, Heart & Stroke
    Foundation of Canada and AGE-WELL. Through Lumino Health, we surface
    health partner articles, videos, podcasts, and events that will be of interest to
    consumers, organized by health topic for ease of use. Topics include fitness
    and lifestyle, diet and nutrition, mental health, aging and caregiving, virtual
    care, family health, home care and more. They have 22 partners that they are
    working with and will continually add partners and their health content to
    benefit Canadian consumers.
  • Plan member can also access Lumino Health through mysunlife.ca or my Sun Life Mobile account.

    Source: Sun Life Focus Update

    RBC offers pharmacogenetics testing for group clients

    RBC Insurance has launched a pharmacogenetic testing program which looks at how genes affect a person’s response to drugs.

    RBC reports the following statistics:

  • When it comes to drug treatment, one size does not always fit all. In Canada, there are approximately 200,000 severe adverse drug reactions every year.
  • Genetic factors can account for up to 95% of individual variation in drug response.
  • More than 1 in 5 Canadians live with a chronic illness, but many are not being prescribed the right drug.
  • Pharmacogenetic testing is a simple saliva test that allows for science to tell you which brands/types of medication will work the best for you based on your DNA. RBC is offering the test at a heavily discounted price of $299. This procedure analyzes all illnesses and types of medication. Get it done once, and it’s done for life. You will forever know which medications are most effective for you based on your genetic makeup, all from the comfort of your own home. The result of the test is less waste, healthier employees, and lower out of pocket costs. The test can be used to ensure you’re on the most effective medication for your body, or as a proactive step in case of any future prescriptions.

    If you are interested in the test, please contact us for more details.

    For more information visit RBC Drug Compatibility Testing

    1) By providing access to this test, RBC Insurance is not giving medical advice to change drugs. The test results are provided to help you and your physicians make decisions about your prescription medications.
    2) Adverse drug events costly to health care system: Vancouver Coastal Health-UBC research, University of British Columbia press release, February 25, 2011, accessed August 9, 2016 from http://cpnds.ubc.ca/faqs/adverse-drug-reactions
    3) Kalow W, Tang BK, Endrenyi L. Hypothesis: comparisons of inter- and intra-individual variations can substitute for twin studies in drug research. Pharmacogenetics. 1998;8(4):283–289
    4) How healthy are Canadians? Government of Canada, 2017
    5) The test is not currently used for biologic drugs, which are specialized drugs derived from living cells to treat many chronic conditions such as rheumatoid arthritis, multiple sclerosis and cancer.

    Changes to Ontario’s OHIP + coming March 2019

    Beginning March 2019, Ontario’s government will no longer cover prescriptions for children and young adults under the age of 25 with private coverage.

    Children and youth who are not covered by private benefits will continue to receive their eligible prescriptions for free, a news release by Health Minister Christine Elliott said, while those covered by private plans will bill those insurers first and the government second. The program was previously open to all people under age 25, regardless of benefits.

    Elliott said she looks forward to “working with insurance groups to ensure a smooth transition to this updated system.”

    OHIP+, enacted by the previous Liberal government just last year, offered free prescription medication for Ontarians under the age of 25.

    It covered the 4,400-plus drugs included in the Ontario Drug Benefit Program, which is used by seniors and those on social assistance.

    Benefits Canada: Ontario Government to become second payer under changes to OHIP

    CBC News: PCS Announce Changes to OHIP

    CP24: Ontario Government announces prescription drug benefit changes to OHIP

    Specialty drugs make up a large portion of plan spending

    Express Scripts Canada’s largest drug trend report Prescription Drug Trend Report – Trends in Canadian Private Drug Spend has reported that employer-sponsored drug plan spending increased 2.5% from 2016 to 2017.

    Specialty medication costs have more than doubled from 15% of total spending in 2008 to 31% in 2017.

    While specialty prescriptions represented just 2% of total claims, they made up almost one-third of total drug spending.

    The factors driving an increase in spending in this category in 2017 included a greater utilization of specialty medications within common conditions such as asthma and high cholesterol. In addition, spending was driven upwards by the introduction of new high-cost medications, and new indication approvals for existing medications.

    Further, this spending is from a small group of claimants. About 20 percent of claimants account for almost 80 percent of the drug spending.

    The report also highlighted non-adherence. Among the 20 percent of claimants who account for 80 percent of the drug spending, half are non-adherent to one or more of their medications. Patients who are not-adhering to their medications impacts both the patients as well as the plan sponsor by increasing the drug spend. Helping patients adhere to their medications results in less wastage and better outcomes for patients. Insurance companies are coming up with methods to assist patients in adhering to their drugs, for example RBC’s Drug Compatibility Testing program.

    While there are new generic and biosimilar drugs coming on the market to help mitigate the costs of specialty drugs, plan sponsors can also encourage methods to control drug spend such as prior authorization and the use of preferred-pharmacy networks.

    Source: Express Scrips Canada Prescription Drug Trend Report – Trends in Canadian Private Drug Spend

    Quebec group insurance pooling update – 2018

    Every year, the Quebec Drug Insurance Pooling Corporation (also referred to as the Société de compensation en assurance médicaments du Québec) revises the Quebec group insurance pooling terms and conditions. New pooling levels and fees will be applied to all 2018 renewal calculations that involve Quebec plan members.

    Who does it affect?

    All group insurers in Quebec contribute to a pooling plan that protects private sector plan sponsors against the financial impact of large claims for drug costs. Based on pooling results from previous years, the Quebec Drug Insurance Pooling Corporation submitted a report to Quebec’s Health and Social Services ministers. The report details 2018 pooling parameters and has been approved by all industry members.

    How does it affect plan sponsors?

    Pooling levels and fees are designed to cover predicted costs for claims and operating expenses associated with prescription drugs. While the overall pooling structure remains similar:

    • all pooling levels remain unchanged and some fees changed slightly for 2018
    • eligible amounts remain the paid claims amounts and the compensation formula is calculated as 100% of the amount in excess of the threshold
    • eligible medications remain those covered by the private plan
    • a per certificate pooling approach continues to apply

    2018 pooling parameters

    2018 Pooling parameters

    Quebec Pooling 2018