GSC Update - January 2023

January 24, 2023

gsc update

Enhancing the Dietitian Health Coaching Program in Group Benefit Plans

Helping plan members live their healthiest lives has always been central to what we do and what we believe in. When we launched the Dietitian Health Coaching Program back in December 2016, our goal was to support plan members and their dependents (over age 16) in the prevention and management of chronic diseases by promoting healthier food choices through interactions with a registered dietitian. We worked closely with dietitians and other experts to develop the program, which is built on evidence-based research, quality control, and valuable long-term outcomes.

We understand that obesity is increasingly becoming a global health issue and is an epidemic in many countries, including Canada. And currently, more than one in four Canadian adults are considered obese, with a higher prevalence among males and those age 40–69 years.1 In addition to the serious health consequences, obesity has significant economic implications, with an estimated 12 per cent of Canadian health expenditures being attributed to obesity.2 We also know that by helping people make healthier food choices, we can work to prevent the onset of chronic conditions, and help those who have already been diagnosed with one to manage their condition and improve their overall health.

We worked with our network partner, Loblaws Inc., to enhance the existing program which will relaunch on March 1, 2023. If you don’t already include coverage for the Dietitian Health Coaching Program, this is a great opportunity to learn more about the program and to start including coverage for it within your benefits plan.

What’s included in the program?

  • Direct access to a registered Loblaw dietitian either in a participating store or through a new virtual experience. We understand that choice of interaction is important to plan members, so the virtual option will be available for those who prefer it.
  • Four sessions delivered over a four-to-eight month period. A comprehensive 60-minute initial session that includes a recommended nutrition plan, a 30-minute personalized practical “hands-on” session – this was previously delivered in a group setting – and two 30-minute follow-up sessions.
  • New meal planning resources shared in a printed or electronic format.
  • The total cost of the program hasn’t increased since its launch in 2016. As a result of the enhancements to the program – which will soon offer more personalized interactions, new resources, and a virtual experience option – the cost will increase from $200 to $275 on March 1, still a great value for the program!

If you want to learn more or increase your current coverage to reflect the cost of the enhanced program, reach out to your account team.

Please note:  the Dietitian Health Coaching program is not a benefit of GSC Individual health plans.

1 CMAJ 2022. DOI:10.9778/cmajo.20210205
2 Cost analyses of obesity in Canada: scope, quality, and implications. Cost Eff Resour Alloc. 2013; 11: 3.

Migraine Management Policy to be discontinued as of February 1

Our Pharmacy and Therapeutic (P&T) committee regularly reviews existing drug policies to ensure they are up-to-date and aligned with the current therapeutic landscape. The committee recently reviewed the policy concerning “triptan” medications for migraines and determined the policy will be discontinued as of February 1, 2023.

Triptan medications are used to stop a migraine that has already started. If they are needed frequently, an individual should be trying preventive options or seeking specialist care to ensure their condition is appropriately managed.

The Migraine Management Policy was created as a safety precaution that involves placing restrictions on the amount of triptan medication an individual can claim without providing more information to the prior authorization team from their prescriber. In the recent policy assessment, we noted prescribing patterns were generally aligned with the guidelines, and very few submissions resulted in internal pharmacist interventions. With the recent market entry of multiple new preventive agents for treating migraines, we have seen improved practitioner understanding of the disease state and a change to prescribing practices.

Although we will continue to monitor triptan medication usage, plan members who were previously restricted by the policy will no longer receive letters or have policy limitations placed on their claims; note that they won’t receive a letter advising that the policy is no longer in place.

Contact your account team if you have any questions.

An update on the Specialty Care Program in Alberta

We previously shared the following key points:

  • Our long-standing preferred pharmacy network (PPN) for specialty drugs is now known as our Specialty Care Program.
  • Our pharmacy team has assumed full responsibility for managing the Specialty Care Program following the acquisition of NKS Health.
  • The program expanded into Alberta in November, with plan members living in Alberta supported by our Specialty Care Program via Innomar Pharmacy and Sentrex Health Solutions. Additional details can be found in the November issue of The advantage.

Since November 14, plan members in Alberta newly approved for a specialty drug and belonging to a group with the Specialty Care Program requirement are contacted by an NKS Assist care coordinator, advised of the requirement to obtain their medication from a participating network pharmacy, and navigated to a network pharmacy of their choice.

Plan members taking a specialty drug prior to November 14 will be contacted soon (in a mailed letter), advising them of the requirement to transition into the Specialty Care Program by March 1, 2023. The letter will indicate whether they need to change their pharmacy (if it isn’t part of the network), and they will be instructed to call NKS Assist and enrol in the Specialty Care Program. Only plan members currently using a pharmacy outside of the network will be required to transition to a different pharmacy.

The first Change4Life® challenge for 2023 is now underway!

There are many reasons for plan members to access Change4Life – from earning points, bidding on rewards in the reward store (with winners drawn each month), participating in the quarterly challenges and testimonial draws, and new for 2023 – qualifying for a bonus draw when a minimum of 2,500 points are earned in a quarter and for bonus points when a health risk assessment is completed.

We’re excited to announce that the newest quarterly challenge started on January 1 – the financial challenge. When plan members set up their Savings Tracker, they will earn an automatic entry into the draw each day they track their savings for a chance to win one of eight $200 gift cards. The challenge ends on March 31. Be sure to check out the Change4Life toolkit for all available promotional materials including resources for the current financial challenge.

If you’re interested in learning more about what Change4Life has to offer, please contact your account team.

Travel coverage and COVID-19

An exception to the standard travel benefits in our Group and Individual plans was introduced in the summer of 2020, adding coverage for emergency medical expenses related to COVID-19. The exception temporarily waived the advisory exclusion within standard travel plans. This exception was initially applied until June 30, 2021, and was extended until December 31, 2022, when it expired.

As of August 1, 2021, a quarantine benefit was included within standard travel plans for fully vaccinated travellers who tested positive for COVID-19 during their trip and were delayed in returning home. This benefit was extended to all travellers on July 1, 2022 – regardless of vaccination status, and also expired on December 31, 2022.

With the expiry of the travel exception and quarantine benefit, as of
January 1, 2023, pre-pandemic limitations and exclusions related to travel advisories once again apply to our standard travel plans.

This means that medical expenses related to COVID-19 will be considered the same as any other illness while travelling outside of an individual’s province or territory of residence, and the presence of an active travel advisory is an important component to eligibility.

  • If a traveller contracts COVID-19 in an area without an active travel advisory in place, treatment is covered.
  • If a traveller contracts COVID-19 in an area with an active level three or level four COVID-19 travel advisory, treatment is not covered – regardless of vaccination status.

2023 provincial dental fee guide adjustments

Each year, GSC updates our claims adjudication system with the current dental fee guides issued by dental associations in each province and territory. The cost impact to plans is dependent on the utilization for each type of procedure code. For example, a two per cent increase to frequently used basic and preventive services will have a higher impact than a two per cent increase to unused or infrequently performed dental procedures. To help determine how these changes may affect your dental plan, the table below provides a summary of the weighted average adjustments to dental fees for 2023 by province and territory.

Dental fee guides are suggested fees that help provide transparency around dental costs and can help educate consumers. While most dental providers follow the suggested fees published in their province/territory, they can bill their own fees according to their individual practice. For example, fees may be reduced or increased based on the amount of time required and/or the level of complexity involved for an individual procedure.

Province/Territory Average increase Fee guide effective date
Alberta 6.00% January 1, 2023
British Columbia 5.99% February 1, 2023
Manitoba 5.25% January 1, 2023
New Brunswick 7.00% January 1, 2023
Newfoundland and Labrador 8.50% January 1, 2023
Northwest Territories 10.50% January 1, 2023
Nova Scotia 5.92% February 1, 2023
Nunavut 10.50% January 1, 2023
Ontario 8.50% January 1, 2023
Prince Edward Island 5.13% January 1, 2023
Quebec 9.80% January 1, 2023
Saskatchewan 5.62% January 1, 2023
Yukon Not yet available April 1, 2023

The fee guide information above was provided by the applicable provincial/territorial dental associations.