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Green Shield Canada

The advantage - December 2020

What’s new…

Virtual physiotherapy delivered at a reduced cost with Phzio Canada

Back in June 2019, it was announced that GSC and one of its partners, BBD, would combine efforts to conduct a pilot project with online physiotherapy provider, Phzio. And a few months later in the December 2019/January 2020 issue of The Inside Story®, the Phzio pilot was listed as an example of GSC continuing to introduce digital health technologies as a way for plan sponsors to engage more plan members to easily and effectively enhance their health. The pilot offered a digital solution to plan members to treat their acute and chronic conditions while eliminating barriers associated with care such as time and transportation.

The initial intent of this initiative was to determine whether virtual physiotherapy delivered remotely, and at a lesser cost, would result in health outcomes that met or exceeded traditionally delivered physiotherapy. It’s important to note that the pilot began pre-COVID-19, when virtual physiotherapy claims weren’t eligible at GSC – or in the industry. Because of COVID-19, we needed to pivot the objective of the pilot to gain a better understanding of the benefits of the Phzio platform to determine whether we would actively promote it to our plan members.

What were the findings of the pilot?

As there wasn’t enough pilot data to provide a statistically significant evaluation, we broadened the dataset to include non-GSC plan members, which allowed us to review self-reported pain levels resulting from 19,450 episodes of care and 48,221 treatments delivered via the platform. On a scale of 1-10, patients starting with an average pain level of 6.6 at diagnosis reported a reduction to an average of 3.9 after 10 days of treatment. At the end of their treatment plan, patients recorded an average pain level of 1.7. In addition to this decrease in self-reported pain levels, the experience was rated as a positive one, and the treatments were delivered at a reduced cost compared to in-person physiotherapy.

COVID-19 has opened the doors to virtually delivered physiotherapy being considered an eligible expense across all benefit plans – regardless of the platform used to connect with patients, whether that be Zoom, Microsoft Teams, FaceTime, or others. What we do know is that the Phzio platform is a much more robust diagnostic treatment-delivery platform compared to other available options.

What’s next?

We’re pleased to announce that Phzio Canada is now offering all GSC plan members preferred pricing to access treatment via their platform. The team providing those treatments includes registered physiotherapists in all provinces across Canada who can provide treatment in English and French. At $59 for an initial visit and $49 for a follow-up visit, GSC-preferred prices are much lower than the fees charged in the physiotherapy community. Better yet, all claims will be billed via providerConnect®, so plan members will only need to pay out of pocket for the amount their plan won’t reimburse – noting all claim payments will flow through the traditional claims experience and are subject to the existing physiotherapy limitations within a benefits plan.

And if a great user experience, virtual care delivered at a reduced cost, and plan members only needing to pay their required out-of-pocket expense and not needing to submit a claim on their own time wasn’t enough, all GSC plan members will have access to Phzio Canada’s MSK360 product: a free resource portal that can be used to address and prevent musculoskeletal and ergonomic issues via videos that demonstrate stretches and best practices.

Read more about the Phzio platform on the Health Care Discounts page on our corporate website.

 

COMING SOON! Fresh new look for greenshield.ca

Coming soon to a computer, tablet, or mobile phone near you, GSC will be launching a fresh, new corporate website that is really going to knock your toques off. Using the latest web technology, the site will offer an optimal user experience and a sleek new design.

So what are some cool new features? The new site is focused on making it even easier for users – specifically plan members, plan advisors, plan sponsors, and individuals shopping for coverage – to get quick access to the information they need. Visitors can head over to the Products & Services section to check out all the new tools and innovations that the GSC team has cooked up. And they can also head over to the Resources section for helpful information and links that will improve their GSC experience. Of course, visitors will have easy access to our publications and episodes of our podcast with content that can be shared on social media. And you will not be able to miss more real life pics of GSCers in their natural habitat… with a nod to the times we live in.

Watch for it in the coming weeks. Just visit “greenshield.ca” – the website URL hasn’t changed – to take a tour.

 

You’ll be hearing more about…

Virtual/tele-orthodontics product coming next year

Earlier this year, we shared information about virtual/tele-orthodontics – what it is, how it improves access by removing certain barriers, and the role that licensed dentists play in the treatment plan and their interaction with patients. As a refresher, it allows patients to receive specific forms of treatment from their home without the need to see a dentist or orthodontist in person, which improves access to care while removing financial and geographical barriers that may be associated with the traditional orthodontic experience. It’s important to note that licensed dentists create the treatment plans and follow the patient’s progress along the way.

Many plan designs today include coverage for orthodontic treatment – typically with co-payments and maximums in place. The benefit has always been used for in-person treatment. Effective March 1, 2021, existing orthodontic coverage will continue to be accessible for in-person treatment; however, that same coverage will also be available to access orthodontic care delivered virtually – noting all existing plan limitations will remain and will apply to the virtually delivered care.

As of March 1, 2021, patients who qualify for virtual treatment (not all orthodontic cases will be eligible) can choose to access orthodontic care via a licensed dentist in person, or they can access virtual orthodontic care via a licensed dentist at a significantly reduced cost of in-person treatment. Successful candidates are determined through the evaluation of an at-home impression kit and 3D images that are assessed by a licensed dentist or orthodontist. Even better, for plans that don’t include orthodontic coverage, plan members will get the same access to a preferred GSC discount for the virtual orthodontics product to reduce their out-of-pocket cost.

Through an independent review conducted by GSC and a licensed orthodontist, it was determined that there is no risk to patient safety with this model of care – which has already been successfully delivered in the United States. And it is within the current scope of practice for dentists and orthodontists in Canada as outlined by their provincial regulatory authorities. You’ll read more about this product and the patient journey in the new year, along with the news of who we’re partnering with to deliver the virtual experience. If you review all of the details and decide that you don’t want to offer this option to your plan members as an alternative to in-person care, you’ll need to contact your account team by January 29, 2021.

 

Introducing GSC’s pharmacogenetics product

Pharmacogenetics is one of several types of genetic testing available for medical purposes. The test results determine whether a person has certain genetic mutations that are known to influence their response to a drug in a certain way. Based on that information, a physician or pharmacist could choose medications better suited to that individual.

Interested in the potential of pharmacogenetics in the treatment of depression and anxiety, GSC initiated a clinical trial to study whether it would improve patient outcomes. Recently, we revealed the results of this study which showed that participants in the pharmacogenetics-guided group reported significantly greater improvements versus the control group, where treatment was based solely on clinical judgement. You can read more about the study and its results in the Summer 2020 issue of Follow the Script®.

We are excited to introduce our new pharmacogenetics benefit, which will be included under all group extended health services plans effective March 1, 2021. This benefit – consisting of a test and access to accompanying software – is offered in collaboration with GenXys, a leader in pharmacogenetics in Canada. While many companies offer similar products, we selected GenXys as our preferred provider because it stood out as a forward-thinking partner that shared our commitment to solving complex health challenges and had developed industry-leading software to support prescribers and pharmacists.

Our goal is to provide access to a product that can improve plan member health. In keeping with the results of our study, eligibility for pharmacogenetics coverage will be limited to those who are most likely to benefit from it in order to obtain optimal drug therapy for depression or anxiety. Given the repercussions of the COVID-19 pandemic, it’s clear a focus on mental health is more important than ever.

What’s next?

Effective March 1, 2021, pharmacogenetics coverage will be automatically added to all group GSC benefit plans that cover the “Diagnostic Services/Laboratory Tests (non optometric)” category, which is covered by the vast majority of our plans. Claims will be subject to GSC’s prior authorization process to ensure costs are managed and criteria is met. While pharmacogenetic testing is associated with an upfront cost and doesn’t necessarily avoid future drug claims (plan members will continue to claim medications for depression and/or anxiety), its value lies in allowing plan members an opportunity to optimize treatment more quickly in an effort to achieve disease control and reduce the risk of disability and associated costs.

Look for more information about the pharmacogenetics product in the new year via a GSC Update. This will include additional product details and an overview of the plan member experience, as well as pricing, estimated uptake, and the expected impact on health plans. If you do not want this product included in your plan, be sure to advise your account team by January 29, 2021.

 

FYI…

An update on GSC’s gender affirmation offering

We first told you about GSC’s gender affirmation work in the September 2020 issue of The advantage. We’re creating this optional product to allow plan sponsors to provide support to plan members throughout their transition/affirmation journey by reimbursing expenses that are above and beyond what’s typically included within a plan design and to help fill the gaps with what’s not covered through a provincial or territorial health care plan.

GSC’s gender affirmation offering includes two categories – one or both can be added to a benefits plan. The two categories are described as “Foundation” benefits and “Focused” benefits and will be available in Q2, 2021 – the exact timing will be confirmed in the new year.

  • Foundation: Includes reimbursement for core surgeries not covered by provincial or territorial coverage and services that assist in the physical alignment of the individual’s transitioned gender. Examples include vocal surgery, tracheal shave, chest contouring/breast construction, vaginal dilators, facial feminization, and laser hair removal.
  • Focused: Includes reimbursement for surgical enhancement of the individual’s features that follows their accepted gender ideal. Procedures include nose surgery, liposuction/lipofilling, face/eyelid lift, lip/cheek fillers, hair transplant/implants, and gluteal lift/implants.

Reimbursement of eligible expenses is subject to a diagnosis of “gender dysphoria” from a medical doctor, in addition to a reasonable and customary fee per claim and an overall lifetime maximum.

We will continue consulting with national and regional associations/groups as we wrap up the product development cycle.

 

In the news: Ontario is reinstating out-of-country coverage

Late last year, we told you that the Ontario government was eliminating the Ontario Health Insurance Plan’s (OHIP’s) limited coverage of emergency out-of-country medical costs effective January 1, 2020. In response, however, the Canadian Snowbirds Association challenged Ontario’s move as a violation of the Canada Health Act.

This past September, the Ontario Divisional Court sided against the government and ruled that OHIP must resume the same emergency out-of-country coverage provided prior to January 1, 2020: inpatient services up to $400 per day for a higher level of care and up to $50 per day for emergency outpatient and doctor services.

This reinstatement of OHIP’s out-of-country coverage will not impact the coverage provided under GSC’s travel plans – your plan members will not see any difference in their benefits or our claims adjudication process for out-of-country emergency medical claims. Booklet wording does not explicitly mention Ontario, so no updates will be needed to accommodate this change. Our travel assistance provider, Allianz, will start the coordination process once OHIP gives the go ahead to do so.

 

BEACON can help plan members through the holidays

The holidays are just around the corner, and while it can be an exciting time for many, it can also be challenging for others. On a related note, surveys show 30 per cent of employees say they’re more stressed on the job this time of year as preparing for the holidays on top of juggling work responsibilities can make this a busy and stressful time. This year, with the added factor of COVID-19, the holidays will be different. Complications such as travel restrictions and susceptible family members mean traditional plans will be changed and, possibly, cancelled altogether, adding more even stress. Some of your plan members are sure to be feeling the strain.

MindBeacon released their new Managing Stress therapy in October to help individuals successfully deal with stress and minimize the risk of developing troubling issues such as anxiety, depression, and substance use. This program can be extremely helpful in developing resilience and better coping during the hectic holiday season. Since the Managing Stress program was released, almost 20 per cent of all BEACON users have accessed it. Read more about it in the September 2020 issue of The advantage.

As COVID-19 cases continue to rise across the country with more shutdowns occurring, we are once again seeing the need for mental health support exceed the available programs that are accessible for Canadians. To help bridge this gap, MindBeacon will be announcing a new service offering starting in January 2021 that will bring more options and choice for therapy to their digital platform. Stay tuned as more will be revealed in the new year. And remember that GSC now offers coverage for BEACON therapy using a per-employee per-month model which completely eliminates the out-of-pocket expense for plan members – leading to increased uptake. Contact your account team for a quote.

 

Quebec Drug Insurance Pooling Corporation issues 2021 update

Each year, the Quebec Drug Insurance Pooling Corporation (QDIPC) reviews its pooling thresholds and fees to reflect trends in the number of claims submitted to the pool in the past. QDIPC recently released its 2021 changes.

Quebec drug pooling impacts all benefit plans under 6,000 plan member lives that have plan members in Quebec. GSC calculates the required premium for each Quebec plan member based on the size of the group. For non-refund plan sponsors, Quebec drug pooling charges are including in the renewal calculations each year. For retention and ASO groups, the pooling charges are included in the retention statement or the ASO reconciliation. If a plan member in Quebec exceeds the pooling limits, claim amounts in excess of the pooling threshold are removed from the renewal calculation and the financials.

 

2021 pooling thresholds and factors:

Size of group i.e., no. of certificates (plan members)

Threshold per certificate (plan member) for 2021

Annual factor (premium) without dependents

Annual factor (premium) with dependents

Fewer than 25

$8,000

$251.00

$691.00

Between 25 and 49

$16,500

$165.00

$455.00

Between 50 and 124

$32,500

$94.00

$258.00

Between 125 and 249

$47,500

$68.00

$187.00

Between 250 and 499

$72,000

$49.00

$135.00

Between 500 and 999

$95,000

$40.00

$111.00

Between 1,000 and 3,999

$120,000

$35.00

$95.00

Between 4,000 and 5,999

$300,000

$16.00

$44.00

6,000 and over

Exempt from drug pooling

Exempt from drug pooling

Exempt from drug pooling