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The advantage - Summer issue

the advantage

WHAT’S NEW

Exclusive vision care offers for GSC plan members: coming soon!

As we continue to grow GSC’s digital health ecosystem, we are pleased to give you advance notice about a partnership with a leading Canadian eyewear e-retailer, who offers a wide range of glasses and contact lenses.

It’s vision care from the comfort of home, positioning customers to browse and select eyewear options from a laptop, phone or tablet, with delivery right to the door.

This new partnership will give GSC plan members exclusive savings as well as an enhanced user experience that reduces their out-of-pocket costs (provincial terms and conditions apply). We look forward to sharing more information with you – and with plan members – in the weeks ahead.

Q3 Change4Life® challenge focuses on getting active

The Q1 Change4Life challenge encouraged plan members to complete their health risk assessment (HRA), the Q2 challenge was all about mindfulness, and the Q3 challenge encourages plan members to get moving and track their steps.

This newest challenge started on July 1 and will end on September 30. When plan members track 35,000 steps each week (through a wearable or by using the manual tracker), they’ll be automatically entered into a draw for a chance to win a $200 gift card prize pack. Eight winners will be selected on October 3.

As part of the promotion to plan members, we’ve also encouraged them to either complete their HRA for the first time or see how their score has changed over time. Remember – the more plan members who complete their HRA, allows you to identify key risk factors of your organization through detailed behaviour-change analytics and reporting insights – as long as you meet minimum reporting thresholds. In addition to seeing aggregate HRA health scores, you can learn about where plan members are most motivated to make changes, see how behaviour results have changed over time, and which tools, education modules, and content your plan members are using the most.

If you’d like to promote Change4Life to your plan members, check out some promotional materials here. You can start by simply encouraging them to register and complete their HRA.

If you want to take the Change4Life experience to the next level via enhancements that range from adding your company name/logo to providing a co-branded experience, running a custom HRA challenge, or even creating a custom reward store, you can learn more about the enhancement options here in the enhancement guide.

Contact your account team if you have any questions.

Adjudication enhancements to improve the plan member experience

We have a team of GSCers (what we call ourselves) who focus on finding ways to optimize existing adjudication processes that result in an improved plan member experience.

  • Prosthetic device claims: As of August 1, statements for claims processed for prosthetic devices will clearly identify a right or left prosthesis (where applicable). This update will result in an improved plan member and provider experience where bilateral prosthetic devices are claimed – eliminating inaccurate duplicate claim denials and manual processes, increased accuracy of utilization reports and audit capabilities, and more accurate reasonable and customary fees. There will be no changes to the overall plan design or to existing reimbursement limitations, such as maximums, co-pays, and deductibles.
  • Orthodontic treatment claims: Historical adjudication practices didn’t allow for the reimbursement of orthodontic treatment claims paid in full. An administrative guideline directed a portion of the payment to the initial fee and the remainder of the payment was divided into monthly fees that were reimbursed over the duration of the treatment plan. As of June 1, orthodontic treatment claims paid in full have been reimbursed according to the existing co-pays, deductibles, and maximums within a plan design. This update brings us in line with industry practices, results in less claims for plan members or providers to submit, and internal efficiencies. Plan members still have the option to pay for orthodontic treatment plans in monthly installments, and claims will be processed accordingly. We anticipate this is how most claims will continue to be received going forward.

ICYMI

Have you checked out Tranquility by Inkblot?

It’s easier than ever to promote a validated and affordable mental health solution to your plan members – GSC’s preferred iCBT solution, Tranquility by Inkblot.

This program has been an eligible expense in most benefit plans since May 1 – subject to existing limitations at the Mental Health Services category – and was added to our Digital Clinic back on May 26. You can read all about the Tranquility by Inkblot launch details in the Q1 2022 issue of The advantage.

For plans that don’t currently include coverage for the program, the discounted cost of $75 (plus applicable taxes) for the self-guided program and $325 (plus additional taxes) for the coach-assisted program are available to plan members. Keep in mind that coverage for the program can be added to a plan at any time.

You also have the option to provide program access to your plan members by paying a per-employee per-month (PEPM) fee. This approach allows plan members to access Tranquility by Inkblot outside of the benefits plan, which means there’s no out-of-pocket cost for the plan member, and no claim for them to submit. They can then use existing mental health coverage included within the benefits plan for other support options.

Get in touch with your account team if you have any questions or if you are interested in receiving a PEPM quote.

YOU’LL BE HEARING MORE ABOUT

Work continues on the creation of our Family Planning product and First Nations benefits review

Diversity, equity, and inclusion (DE&I) continue to be top of mind when creating new products at GSC. The first signature product resulting from this focus was our Gender Affirmation offering. In June 2021, we included it in all ASO and non-refund Group plans as a standard benefit – enabling plan sponsors to support plan members throughout their gender transition journey. We learned the importance and value of consulting with a wide range of professional associations and organizations when creating the Gender Affirmation offering, allowing us to strengthen our understanding of the challenges and gaps that existed for individuals who would access the product, and using those learnings to create something that would resonate and bring the most value to the transgender community.

Family Planning product

We are taking the same approach as we actively develop our Family Planning product – one that will launch later this year. While our rules-based adjudication system has allowed us to reimburse claims for eligible fertility-related expenses for many years now – including in vitro fertilization (IVF), intrauterine insemination (IUI), artificial insemination (AI), sperm wash, and eligible prescription drugs, it is critical that we once again create a fulsome product that will be considered a valuable addition to benefit plans by plan sponsors and one that plan members will view as supportive to their needs.

To date, we’ve combed through research, consulted with advocates and experts, reviewed available provincial and territorial funding, identified the barriers individuals face when navigating through fertility challenges, and made adjustments to the product along the way. We have also met with individuals with lived experiences with surrogacy and adoption with the goal being to find a way to allow related expenses for these family building options to be reimbursed through the Family Planning product.

First Nations benefits review

We’ve also invested time to better understand the unique challenges faced by our First Nations, Inuit, and Métis plan members through their health care and benefits plan experience. Connections have been made and relationships have been established with knowledgeable individuals and supportive organizations over the past several months, which will allow us to focus on enhancing enrolment processes, better understanding how coverage through the Non-Insured Health Benefits (NIHB) program is accessed, claim coordination expectations with NIHB (where applicable), and where gaps may exist for expenses that are traditionally not covered through an extended health, drug, or dental plan.

Continuing to work with individuals in these communities and better understanding their health care journey will be pivotal to achieving our goal, which is to improve the overall plan member experience and to create awareness.