OCTOBER 28, 2021
Updates to ‘Out of Country Coverage’. See ‘Travel’ tab for more information.
SEPTEMBER 25, 2021
Updates to ‘Layoff Provision’. See ‘Business Relief Measures’ tab for more information.
JULY 3, 2021
Information updated under ‘Business Relief Measures’.
MARCH 16, 2021
Contrary to misinformation being shared online, the Canadian Life and Health Insurance Association (CLHIA) states that receiving a COVID-19 vaccine will have no effect on the ability to obtain coverage or benefits from life insurance or supplementary health insurance. Read the Press Release Here.
JANUARY 20, 2021
Information updated under ‘Travel’, ‘Disability’, and ‘Business Relief Measures’ Tabs.
VISITING THE OFFICE
COVID-19 VISITOR HEALTH & SAFETY PROTOCOLS
GroupHEALTH has developed the following visitor health and safety protocols to ensure we protect the physical, mental health, and safety of both employees and visitors while adhering to all public health policies and guidelines. Hosts (an employee hosting a visitor) are required to advise visitors in advance of these protocols and should provide an advanced copy of this document to all visitors.
During the COVID-19 pandemic, wherever possible, business should be conducted virtually, however there may be occasions where visitors need to come to our physical office locations. Visitors also include any contract staff such as cleaners, trades and vendors. The following protocols must be followed:
Visiting Company Offices
To prevent the spread of COVID-19 throughout the workplace, in all cases the following visitors shall not be permitted to visit any GroupHEALTH workplace:
- Any visitor that appears to have COVID-19 symptoms (i.e. fever, cough, or difficulty breathing), until such symptoms have passed.
- Any visitor that has tested positive for COVID-19. Visitors are not permitted until the visitor tests negative for COVID-19 and has completed any self-isolation period mandated by public health authorities. If the visitor is unable to be tested, the visitor should not visit any GroupHEALTH office until they have completed any mandated self-isolation period and are free of symptoms.
- Any visitor that has been in close physical contact with another person diagnosed with COVID-19. The visitor should not visit any GroupHEALTH workplace until the visitor has completed any mandated self-isolation period and does not present any symptoms.
- Any visitor who has travelled internationally until the visitor has completed self-isolation/isolation requirements as outlined by either the Canadian Federal Government, or Provincial Health Officer in the Province of the office location.
Protocols While Visiting an Office
Because our team members appreciate the collaboration, tools, and camaraderie that they experience when they are working together in our offices, GroupHEALTH will begin a phased process for our team members to return to our offices.
- All visitors visiting any GroupHEALTH office are required to report to reception to identify themselves and are required to complete a COVID-19 pre-screening questionnaire. Active COVID-19 screening is a requirement in both BC and Ontario under the current Provincial Health Authority directives.
- Visitors will be asked to provide their name, telephone number, email address, date and time of visit, and name of the host. This information will be logged at reception and used to assist with any contract tracing efforts in the event of an outbreak.
- All visitors to GroupHEALTH offices are required to perform a temperature assessment at reception prior to proceeding with their visit. A visitor whose temperature check exceeds 38° Celsius (100.4° Fahrenheit) will be asked to postpone their visit.
- All visitors are expected to wear a face mask in all public and common areas (for example, hallways, bathrooms etc.). Visitors are not required to wear a face mask when attending an in-person meeting in a meeting room where physical distancing can be maintained.
- If a visitor prefers to wear a face mask in a meeting room, they may do so at their own choice. In circumstances where a visitor does not have a non-medical face mask, one will be made available at reception.
- Visitors must always be escorted by the host when beyond the reception area. Exceptions to this are any contract staff such as cleaners, trades and vendors who have received advanced permission, and access to areas beyond reception.
- When an employee is considering hosting a meeting, they must ensure that the meeting room chosen allows for 2 meters physical distancing and does not exceed the COVID meeting room capacity. Room capacity is posted outside each meeting room.
- An employee hosting a meeting should ensure that all surfaces in the meeting rooms are disinfected prior to the start of the meeting, and at the conclusion of the meeting. Disinfectant wipes are available in each meeting room.
The COVID-19 pandemic has impacted people in many ways. The level of sensitivity to health and safety concerns will vary depending on everyone’s personal circumstances and situation. As such, we ask that all employees and visitors make every reasonable effort to adhere to these Health & Safety protocols and respect one another.
Reporting of Deficiencies
Employees or visitors who encounter any deficiencies related to these protocols are encouraged to notify Human Resources as soon as possible.
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.
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
Federal and Provincial governments may update employment and insurance provisions under Employment Standards and related Statutes due to the COVID-19 pandemic (for example, extending layoff provisions), and these may impact how the coverages in your benefits plan have to be administered. GroupHEALTH is prepared to support any and all administrative provisions outlined in Federal and Provincial regulations.
Where, through regulation or legislation related to the COVID-19 pandemic, eligibility for benefits has been required to be extended, existing layoff provisions in each benefits plan will begin after the final date of government-protected layoff periods.
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. (IA is on a case-by-case basis only, please speak to your GroupHEALTH contact for further information.) Until further notice, 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 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. Premium rates will remain unaffected by this other than any “normal” change at renewal.
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.
Employees laid off due to COVID may continue to be covered for all benefits until September 25, 2021 on a premium-paying basis provided all laid-off employees in a class are treated consistently. We will be extending our allowance for continuation of LTD during COVID-related layoffs to match IDEL requirements until December 31, 2021 and will apply it to all provinces.
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.
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 16, 2020 may be declined.
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.
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 symptoms, are unable to work and have STD you can access your short-term disability benefit. STD will be adjudicated according to the plan provisions. If you have been diagnosed with COVID-19 but are in quarantine, isolation or are asymptomatic, access the government benefit plan.
|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, we suggest that you access the government benefit plan.
OUT OF COUNTRY COVERAGE INSURED BY IA
The Government of Canada has announced changes to travel advisories which may impact your benefits plan. You can read travel advisories here.
Eligibility for emergency medical travel coverage and trip cancellation coverage under your benefits plan can depend on whether your destination appears on Government of Canada travel advisory lists, and the type of advisory in place for that destination.
As of October 23, 2021, the Government of Canada’s travel advisories also distinguish between vaccinated and unvaccinated travellers – that is, the Government of Canada continues to advise against non-essential travel to all destinations for travellers who have not been vaccinated against COVID-19, while downgrading advisories to some destinations for vaccinated travellers.
Effective October 23, 2021, emergency medical travel coverage and trip cancellation coverage provided through your benefits plan will revert to standard policy language, as captured in your benefits handbook. For most plan members this means that eligibility for coverage under their policy will be based, in part, on the plan member’s verifiable vaccination status at the time of the medical emergency that gave rise to the claim.
Note that travel considered essential by the Government of Canada will continue to be covered under the terms of your benefits plan, except to a destination with a Government of Canada advisory to avoid all travel.
A special “90 day travel” administrative exception that may have existed on your benefits plan is no longer valid; your emergency medical travel coverage and trip cancellation coverage provided through your benefit plan will revert to standard policy language as of October 23, 2021.
Travel to countries with a Government of Canada “Avoid all travel” advisory will remain as an exclusion under your plan.
Should a plan member travel to a country in which the Government of Canada travel advisory changes to “Avoid non-essential travel” to “Avoid all travel” while the member is there, the plan member will continue to receive coverage but will be expected to return to Canada as soon as possible.
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.
RAPID TEST COVERAGE
If you choose to travel voluntarily, the rapid test cost required to come back into the country is a known cost of travel, and it is at your expense. If you travel for work, approach your employer for more information regarding coverage.
COVID-19 tests and vaccines are eligible under a Health Spending Account (HSA) if prescribed by a physician or nurse practitioner (MD or NP). If you are tested at the airport or in another country (for travel purposes) and are charged, a referral from an MD or NP indicating that the test was medically necessary is required to receive reimbursement under an HSA.
COVID tests are not eligible under insured plans.
Provisions regarding trip cancellation will remain unchanged: any booking of travel to countries with a Government of Canada “Avoid non-essential travel” or “Avoid all travel” advisory at the time the booking is made will not be eligible for trip cancellation insurance.
If Your Employee Benefit Plan Includes Managed Rx and Maintain Rx (Alliance Pharmacy), or Postscripts (Rexall)
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:
Fax: 905-949-3029 Attention: Special Authorization
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:
- 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
- Practitioners must maintain clinical records for all provided services in accordance with all the requirements for in-person care
- 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
- Practitioners must provide follow-up consultations and care as appropriate
- 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:
- Naturopathic Doctor
- Occupational Therapist
- Psychologist/Social Workers/Registered Clinical Counselors/Psychotherapists
- Speech Therapists
Ineligible Virtual Health Practitioners:
- Massage Therapist
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 PLAN MEMBERS AND THEIR FAMILIES
RESPONDING TO COVID-19
MENTAL HEALTH RESOURCES