Coronavirus (COVID-19)

What you need to know

UPDATES

SEPTEMBER 3, 2020

In response to the COVID-19 pandemic, in March 2020, GroupHEALTH and DMI’s offices were closed to all but essential on-site team members.

Remote Work Arrangements
We focused on providing our clients and plan members with uninterrupted service and support while transitioning our team members to work remotely. Our clients have told us that they appreciate the continuity of service we have been able to provide during these disruptive times.

Returning to the Office
Because our team members appreciate the collaboration, tools, and camaraderie that they experience when they are working together in our offices, GroupHEALTH and DMI will begin a phased process for our team members to return to our offices beginning this fall.

Our priority is to ensure that our team member’s return to office is safe while ensuring that we continue to provide our clients and plan members with uninterrupted service and support. This includes continued flexibility for employees with health or childcare challenges, and physical safety measures that comply with provincial public health and safety protocols.

Our Next Steps
Initial phases of our plan are entirely employee-led: GroupHEALTH and DMI team members can volunteer to return to our offices, subject to safety standards, and many may take advantage of a “hybrid” office + remote work arrangement.

Our plans also include continued monitoring of public health advisories, and a contingency to reinstate mandatory offsite service should circumstances warrant.

Navigating What Comes Next
We know that many of our clients have also had to implement remote work arrangements for their employees, and we appreciate the complexity of these decisions. We’ve added some resources to the ‘Resources for Business’ tab, that GroupHEALTH and DMI have consulted for our planning, in the hopes that these may also be helpful to you and your business.

We will continue to monitor the evolving situation and follow the guidance of our federal and provincial governments and health authorities, making any necessary adjustments to our return to office plan as changes arise.

Stay safe.

MARCH 26, 2020

Use this COVID-19 “hub” to get the latest information about COVID-19 and your benefits plan.

  • GroupHEALTH has announced new relief measures to support Canadian organizations through challenging times. See the Business Relief Measures page.
  • Read how COVID-19 might impact common disability scenarios on the Disability page.
  • Prescription drug supplies remain strong, pharmacies are taking important measures to keep it that way. Read about these measures, and changes to home delivery options, on the Prescription Drugs page.

WE’RE READY TO SUPPORT YOU

This is an unprecedented time for Canadians, as we come together to meet the challenge of COVID-19, the Coronavirus. We know that our families, friends and neighbors are anxious about what COVID-19 means for their health, their relationships and their livelihoods.

And we know that businesses and organizations across the country are making some difficult decisions to preserve what they’ve built for better times ahead.

We want you to know that we’re here to support you. Our commitment to you is that GroupHEALTH will continue to ensure that your employees and your business get the best benefits experience, even during challenging times.

Stay safe, stay connected, and stay well.

The GroupHEALTH Team

WE’RE A FULLY OPERATIONAL “VIRTUAL” TEAM

In order to ensure continued service, and in light of public health authority’s “social distancing” recommendations, GroupHEALTH’s team is now working remotely. While we have implemented measures to minimize service impacts, clients and plan members may experience slight delays as we adjust our processes during these unusual circumstances. Plan Administrators are encouraged to email questions or concerns to their regular contacts at GroupHEALTH for continued service.

OUR SERVICE PROVIDERS ARE READY TO SUPPORT YOU

GroupHEALTH is in regular contact with its partners and service providers to ensure continuity of service. They’re committed to ensuring that employee benefits plans are fully operational during these challenging times.

WE’LL STAY IN TOUCH

We’re committed to continuing communications with you as the situation changes. Where appropriate, we’ll email you with important updates. And you can always check this page for the latest information.

BUSINESS RELIEF MEASURES

The following are all temporary changes to administrative practices or temporary adjustments to some policy conditions which apply to all SSQ, Empire and La Capitale  policies (except where otherwise noted) administered by GroupHEALTH. We will not be changing group insurance policies or member handbooks.  All these adjustments are subject to constant review as the COVID-19 related situation changes and may be changed at the Insurer’s sole discretion. Dates will be reviewed as the situation unfolds further. Updates of any changes will be provided.

PLAN MEMBER REDUCTION TO WORK HOURS

We are making an exception for employees who are working reduced hours due to COVID-19. Until further notice (or until May 31, 2020 for La Capitale policies), we will not apply our standard requirements related to the minimum number of hours worked to be eligible for benefits.

MINIMUM NUMBER OF EMPLOYEES

We are making an exception until further notice (or until May 31, 2020 for La Capitale policies) for groups that fall below the minimum number of employees when an employer has reduced the number of employees due to COVID-19 below the minimum required.

COVERED BENEFIT AMOUNTS

Unless instructed otherwise by plan sponsors, benefits that are salary based will be adjudicated based on the coverage for which the premium is being paid. Employer and employee premium rates will remain unchanged as we are committed to covering the current amounts on record.

If plan sponsors want to insure employees at their reduced hours for a corresponding decrease in benefits they must submit an earnings change in WEBS online.

LAYOFF PROVISION
  • Customers that currently have a layoff provision in their group insurance contract can retain their current provision as is: to allow all benefits (except short-term and long-term disability) to be extended for the period stated in the contract.
  • New option available for a limited time (or until May 31, 2020 for La Capitale policies) as a result of COVID-19:
    Customers that currently have a layoff provision in their group insurance contract which already includes short-term and/or long-term disability can allow short-term and long-term disability benefits (as applicable) for all their employees to continue in the layoff period but subject to a maximum period of three months (or 60 days for La Capitale policies) (or the extension period for other benefits, if shorter).
    • Given the urgency related to COVID-19, We will, upon request,  consider implementing the new layoff provision retroactively (no earlier than March 16th)

Until the end of July 2020 we are allowing a person to satisfy the elimination period for both short- and long-term disability while on temporary layoff. Exceptionally, short-term but not long-term disability benefits may commence during the period of layoff if the elimination period ends during the period of layoff. For La Capitale policies only, for LTD for any disability with a date of disability during the first 60 days of temporary layoff, satisfying the elimination period will not commence until the planned return to work date.

Standard reinstatement provisions apply.  If a member returns to work within 12 months from the last day worked, they are eligible on the plan as of the day they return to work without medical evidence required.  For reinstatements outside 12 months, medical evidence may be required.

PREMIUM PAYMENT GRACE PERIOD

COVID-19 is putting a financial strain on many Canadian businesses. To help our customers during this challenging time, we will, upon request, extend the grace period for the March, April and May 2020 premium payments to 60 days.

Please note that claims suspension may be applicable during extended grace period.

SUSPENSION OF BENEFIT PLAN

Some customers may wish to temporarily suspend their entire benefits program or specific benefits, due to economic uncertainty. We are prepared to allow such suspension to the end of June 2020 with no penalty to reinstate, on a case by case basis.

The pre-existing condition clauses will not restart once the plan is reinstated. No late entrant rule will apply to those that were hired during the period of suspension if they are added as soon as they are eligible after the suspension period is ended.

The following options are available up to end of June 2020 (or until May 31, 2020 for La Capitale policies):

  1. Suspend the entire program for all employees. The policy will remain active with no benefits available to any employees (active or laid-off).
  2. Suspend specific benefits (by class for groups over 10 lives, where the class was defined prior to 15 March).
    • You can choose to suspend Dental or Extended Health or both
    • Please note that Life, ASI or AD&D, and Dependent Life must remain in place if they are currently included in your contract if you wish to suspend only specific benefits. *Note coverage will follow RAMQ guidelines.

During a period of suspension, it is important to note that any claims incurred, including disability claims, will not be covered.

Note: Employers should check with Employment Standards in their province and be aware that the Termination or Suspension of Benefits may result in Constructive Dismissal and/or have other legal implications. GroupHEALTH strongly advises that any changes in this regard be reviewed by a Labour lawyer prior to implementation.

AMENDMENTS TO ADD OR INCREASE WEEKLY INDEMNITY / SHORT TERM DISABILITY COVERAGE

All policy amendment requests to add or increase short-term disability benefits submitted prior to March 16, 2020 are being processed.  Requests received on or after March 16th will be declined due to the risk of anti-selection.

Further details regarding the measures above will be made available shortly. Insurers may at their sole discretion change or cancel any of the above measures at any time without prior notice. All terms of the group policy continue to apply.

CHANGING COST SHARE ARRANGEMENTS

GroupHEALTH plans must continue to meet the minimum requirements of 50% paid by the employer (with some exceptions resulting from employee paid non-taxable disability). However, clients can change cost-share arrangements, as long as the minimum 50% paid by the employer requirement is met.
GroupHEALTH will allow a change from taxable to non-taxable disability benefits; note that this will have plan design and possible rate impact, per standard amendment processes.

DISABILITY

COMMON DISABILITY SCENARIOS
What Happens If Source of Income Replacement
My company shuts down and I am laid off? Programs such as Employment Insurance (EI) are designed to cover wages lost as a result of a company shut down, for whatever reason.
Schools are closed and I need to stay at home to look after the kids? This varies from company to company. If you do not have personal days or vacation days your employer may make an exception. Various levels of government are working on assistance programs and we will know more in the coming days.
​I need to self-quarantine because I have flu-like symptoms? If your company provides a short-term disability benefit and you are sick and unable to work, you may be eligible for benefits. Employment insurance(EI), also has a sickness benefit available to everyone who pays into EI.
I have been diagnosed with COVID-19? If you are diagnosed with COVID-19 (with or without symptoms), are unable to work and have STD you can access your short-term disability benefit. For these claims only, the waiting period will be waived.
I need to self-quarantine, because I just got back from international travel? ​If you can work from home while self-quarantined, that’s great. If you cannot work from home and your employer will not continue to pay you, you can apply for employment insurance.

Short-Term Disability

The unusual challenge of COVID-19 has altered the way that short term disability claims will be adjudicated. As of March 20, 2020, the following guidelines will be followed:

  1. The STD waiting period will be waived for all positive COVID-19 tests, whether symptomatic or not, and where the claimant is unable to work from home.
  2. The STD waiting period will not be waived if a claimant is symptomatic but has not had a positive COVID-19 test. These claims will be adjudicated following normal practices, with possible referral to Employment Insurance.
  3. If a claimant is quarantined, self isolating and asymptomatic, they will be referred to Employment Insurance.

TRAVEL

OUT OF COUNTRY COVERAGE

Benefit plans offered through GroupHEALTH with out-of-country medical coverage will be impacted by the COVID-19 outbreak. This coverage generally contains a condition that excludes expenses incurred in a country or region where the Government of Canada has posted a travel advisory.

This exclusion does not apply to plan members already present in the location at the time the Government of Canada issues a travel advisory, provided they then take the necessary measures to comply with the advisory as soon as possible. Those plan members who qualify for out-of-country coverage and experience significant time in quarantine should expect to receive coverage throughout, up to the limits of their policy as set out in their benefits handbook.

On March 13, 2020, the Government of Canada issued a “Level 3” travel advisory, recommending against all non-essential international travel to any destination. This advisory has an impact on your out-of-country travel coverage. We strongly recommend that you alert your plan members to this change, as it should be factored into international travel plans.

Per the travel advisory, the Government of Canada suggests that all Canadians already out-of-country consider returning to Canada, especially as commercial transport options become more scarce.

As usual, please refer to your benefits handbook for specific details of your coverage, including who insures your plan’s out of country coverage. Each insurer has further information available on their websites.  

TRIP CANCELLATION

For those employee benefit plans that includes trip cancellation coverage, the trip must be bought before the Government of Canada has issued an advisory not to travel to such locations to be eligible for coverage. The advisory must be in force for the period of the planned trip or stay and have been issued after the plan member has already finalized the travel arrangements, or when the insured was already staying in such locations.

PRESCRIPTION DRUGS

If Your Employee Benefit Plan Includes Managed Rx and Maintain Rx (Alliance Pharmacy), or Postscripts (Rexall)

Prescription Drug Supplies and Distribution
Pharmacy distribution channels and supplies are strong, but to help preserve inventory levels some maintenance medications will be limited to a thirty day supply, rather than the usual 90 day supply, in keeping with the recommendations of health authorities. Details regarding limits will be available from your pharmacy at time of order/re-order.

Prescription Drug Delivery
Due to changes in delivery services by Canada Post and FedEx in response to COVID-19, new protocols are in place for parcel delivery:

    • Service guarantees are suspended
    • Post office and pick-up location hours of service will be reduced. Parcels will be held for an extended period at post office and pick-up locations.
    • Door Delivery: Knock, drop and go approach will be implemented. In some cases, a package may be routed directly to a pick-up location and a delivery notice card may be left at the door OR in your mailbox/community box.

Where appropriate, delivery will be directed to post office or courier locations. Pharmacy employees can assist with identifying a pick-up location near you and will ship directly to that specific location.

If home delivery is more appropriate, due to isolation or health vulnerabilities, a “knock, drop and go approach” will be taken with home deliveries. You should be alert to deliveries and immediately safeguard your packages. Tracking inquiries are very challenging at this time as delivery providers are overwhelmed with increased shipment volumes. In the event of a missing package pharmacies will do our best to try and accommodate replacements on a case by case basis.

SPECIAL AUTHORIZATION & COVERAGE NAVIGATION

ClaimSecure will continue to accept Special Authorization and Coverage Navigation Service forms. However, all responses are only being communicated through email at this time. Plan members should include their email address when submitting forms.

FORMS CAN BE SENT TO:

Special Authorization

special.authorization@claimsecure.com

Fax: 905-949-3029 Attention: Special Authorization

Coverage Navigation

coveragenavigation@claimsecure.com

Fax: 905-949-3029 Attention: Coverage Navigation

EMPLOYEE ASSISTANCE PROGRAM WITH LIFEWORKS

For those GroupHEALTH benefit plans that include LifeWorks, even during “social distancing” you have access to the support you need to manage stress, anxiety, grief, and financial concerns.

LifeWorks has taken the steps to ensure that they will continue to be available to provide members with 24/7 assistance. Professional counselling is available through tele-counselling, video counselling, and group virtual sessions for those that require support in dealing with COVID-19.

Log in on the LifeWorks website or mobile app and search COVID-19 to find the latest resources available to support you and your plan members.

HOW TO ACCESS LIFEWORKS

Login to the LifeWorks app or at lifeworks.com:

User ID:  health | Password:  Support 

By telephone, toll-free:

Call 1-866-331-6851 (English) or 1-800-565-9973 (French)

VIRTUAL HEALTH PROVIDERS

COVID-19 has impacted the ability for health practitioners to be able to provide in-person services to their patients. Practitioners are now looking for virtual solutions for their services, some of which may be covered under employee benefits programs. Always consult your benefits handbook to see if services offered by various practitioners are covered in your plan. Note that claims are subject to reasonable and customary limits.

To be eligible for claims reimbursement, practitioners must be able to demonstrate that they are meeting the standards for virtual healthcare services:

  1. Practitioners must be providing a service for a patient that has a clinical file, including a record of an initial assessment conducted in the preceding 12 months
  2. Practitioners must maintain clinical records for all provided services in accordance with all the requirements for in-person care
  3. Practitioners must ensure that communication technology used and the physical location of the practitioner and patients does not compromise the privacy and confidentiality of the patient’s Personal Health Information
  4. Practitioners must provide follow-up consultations and care as appropriate
  5. Receipts from practitioners should clearly state the service was provided through telehealth

Below is a list of those health practitioners who are eligible to claim for virtual services and those that are not.

Eligible Virtual Health Practitioners:

  • Chiropractors
  • Audiologists
  • Physiotherapists
  • Dentists
  • Dietician
  • Naturopathic Doctor
  • Nutritionist
  • Occupational Therapist
  • Psychologist/Social Workers/Registered Clinical Counselors/Psychotherapists
  • Speech Therapists

Ineligible Virtual Health Practitioners:

  • Acupuncturists
  • Osteopath
  • Podiatrist/Chiropodist
  • Massage Therapist
  • Optometrist/Optician

The standards of service and the eligible health practitioners are subject to change as federal and provincial orders and regulations change.

VIRTUAL HEALTHCARE WITH AKIRA

Always check your benefits handbook to confirm your coverage

Many GroupHEALTH employee benefit plans include virtual healthcare, powered by Akira, an online service that provides on-demand access to medical assistance wherever you are and whenever you need it. Over 50% of primary care concerns traditionally seen in a doctor’s office can be addressed through the Akira virtual healthcare app and website, without ever having to leave home or work. Akira connects you with primary care providers without the need to see a health practitioner in person.

PROTECT YOURSELF USING VIRTUAL HEALTHCARE

Virtual healthcare can be especially useful during times like these:

    • Use Akira’s online self-diagnosis tool
    • Contact Akira virtually if you’re concerned that you may have COVID-19 symptoms
    • Use Akira for other medical inquiries, to avoid in-person doctor and clinic visits

If your GroupHEALTH employee benefits plan includes virtual healthcare powered by Akira, start here.

YOUR EMPLOYEE BENEFITS PLAN DOESN’T YET INCLUDE AKIRA?

You can still access Akira, for a fee, at akirahealth.ca.

HOW YOU CAN GO DIGITAL

FOR PLAN ADMINISTRATORS

Billing is Now Paper Free
To accommodate remote work arrangements for our team members in response to public health authority recommendations, effective immediately GroupHEALTH will not be mailing paper bills to clients. Bills are available to all clients via WEBS. 

Read more about Paper Free billing here.

FOR PLAN MEMBERS

Go Paper Free for quicker claims processing
In order for plan members to experience the quickest turn-around time for claims processing and payment, we encourage them to use the electronic claims submission and direct deposit options that are available to them through their claims submission platforms and apps. 

If you have questions on setting up these services, reach out to us at: 

RESOURCES FOR BUSINESSES

If you need this information in French, please contact your GroupHEALTH representative.