Legislation in 2007

#131

Printer-friendly version

A look at what happened and its impact on group benefits plans
Federal and provincial legislation can have a considerable impact on group benefits plans. Here’s a recap of some of the significant legislation that took place in 2007.

Because we have already communicated many of these issues in previous Focus Updates, we summarize the issue, where possible, and provide a link to the original communication.

BRITISH COLUMBIA
B.C. PharmaCare no longer provides retroactive reimbursementOn May 31, 2007, British Columbia passed Bill 31, Human Rights Code (Mandatory Retirement Elimination) Amendment Act. It received royal assent and comes into effect in January 2008.

Bill 31 changes the definition of age to remove the current upper age limit of 65 years. The legislation also provides that the determination of premiums or benefits under contracts of life or health insurance may continue to differentiate on the basis of age without contravening the Human Rights Code.

Impact on your plan
Though we don’t see any necessary contract changes resulting from the legislation, you may want to seek advice to ensure you understand the full impact of these changes on your human resources practices.

If you want to provide coverage for plan members over 65
With the exception of Long Term Disability, which terminates at 65, we can offer the option to continue benefits beyond age 65. Generally, Extended Health Care and Dental can be offered to the earlier of age 70 or retirement. Life and Accidental Death & Dismemberment coverage also extends to age 70. Some exceptions to these standards may be available.

We’ll continue to review our product portfolio to ensure we’re able to meet the needs of plan members staying in the workforce beyond age 65.

For more information, refer to Focus Update # 117 or go to Bill 31


BRITISH COLUMBIA
B.C. PharmaCare no longer provides retroactive reimbursement
B.C. PharmaCare announced it will no longer reimburse families for prescription or medical supply costs they incur prior to registering for the province’s Fair PharmaCare program. The change takes effect January 1, 2008.

Only when individuals or families register for Fair PharmaCare can they be assigned the appropriate income-based deductible. Expenses they incur are then applied against the deductible. Fair PharmaCare has been reimbursing residents for expenses they incur between January 1 and the date they register for Fair PharmaCare, and which are over and above the deductible they are assigned. This will no longer be the case as of January 1, 2008.

Eligible costs for the year continue to count towards the deductible / family maximum for people who register later in the year, provided the individual or family:

  • Incurred the costs while actively enrolled in the province’s Medical Services Plan.
  • Registers in the plan and has their net income (as reported to the Canada Revenue Agency) verified by PharmaCare before December 31.

Note: If a family’s deductible is lowered part way through the year, PharmaCare will reimburse any eligible costs the family paid during the year in excess of their new (lower) deductible from the later of:

  • The date the family was registered for Fair PharmaCare, or
  • The date of the most recent changes in their family structure (i.e. addition or removal of a spouse from their PharmaCare record).

We don’t see this having any impact on your group benefits plan. For more information, go to Fair PharmaCare Retroactive Reimbursement

ALBERTA
Alberta pharmacists can now prescribe certain drugs
In August 2007 we informed you that Alberta pharmacists can now prescribe certain drugs, administer some injections, and play a bigger role in medication management. As for their fees for providing these services, Alberta Health and Wellness hasn’t indicated if it will cover these new charges.

For more information on their prescribing authority and our claims practice for practitioners eligible to prescribe drugs, please refer to Focus Update # 123.

Though we accept claims for drugs prescribed by pharmacists in Alberta, we don’t cover professional fees for pharmacists under our extended health care plans. However, these fees are eligible expenses under Health Spending Accounts

Alberta extends coverage for some optometrist visits
Alberta now covers medically required optometrist visits through a new agreement with the Alberta Association of Optometrists. The change, effective October 1, 2007, covers residents ages 19-64.

Coverage is limited to the following conditions or instances, and there are restrictions on the frequency of visits. Routine eye exams aren’t covered.

  • Diabetes or hypertension as diagnosed by a physician
  • Cataracts, glaucoma, ‘red eye’ or retinal disease
  • Removal of a foreign object from the eye
  • Prescriptions for Hydroxychloroquine Sulfate (Plaquenil).
  • Referrals from a physician or nurse practitioner
  • Other specific disease, illness or trauma listed in the province’s Schedule of Optometric Benefits.

By steering patients with these conditions toward optometrists, this program is looking to reduce emergency room workloads.

Although we don’t anticipate any impact on your group benefits plan, we’re still waiting for clarification from CLHIA as to how this program will be administered. More details are available at Alberta optometrist visits

SASKATCHEWAN
Saskatchewan Seniors' Drug Plan
On July 1, 2007 the government of Saskatchewan implemented a new Seniors' Drug Plan. Under the program, seniors pay no more than $15 per prescription for drugs in the Saskatchewan Drug Formulary.

Seniors don’t need to apply for the program since they’re automatically eligible once they turn 65. More information about the program is available at Seniors’ Drug Plan (English only).

Impact on drug plans
If your drug plan provides coverage for Saskatchewan residents over age 65, you may have seen reduced claims costs for Saskatchewan seniors. We don't, however, see the impact as being significant for most of our customers with seniors in Saskatchewan.

This change doesn’t affect our current claims thresholds for Saskatchewan plan members.

ONTARIO
Ontario’s Bill 151 good news for some ASO contract holders
Prior to Ontario’s Bill 151 - An Act to enact various 2006 Budget measures and to enact, amend and repeal various Acts – only Unfunded ASO plans received an Ontario Retail Sales Tax (ORST) exemption when the Employer Health Tax (EHT) is payable on ASO disability claims (i.e. employer-paid). ORST is payable on the fees related to administering this type of plan.

The exemption now applies to Funded ASO plans when the disability claim amounts are included in the EHT calculation. (We consider a plan to be funded when amounts paid into a plan cover all potential benefit payments to plan members for a period of more than 30 days). Funded and Unfunded ASO plans are now on an equal footing from an ORST perspective.

Along with addressing this inequity, Bill 151 requires that plan sponsors designate their ASO plan as Funded or Unfunded. We rely on this declaration to ensure we apply the appropriate premium and sales tax to the plan.

We’ve been in touch with affected ASO plan sponsors to ensure that we comply with all Bill 151 requirements.

For more information on Bill 151, please refer to Focus Update # 108.

QUEBEC
Quebec amends basic drug plan
Changes to the drug plan administered by the Régie de l’assurance maladie du Québec (RAMQ), effective July 1, 2007, affect plan sponsors who provide drug coverage to Quebec plan members.

Legislative change

Drug claims for your Quebec plan members

Increase in annual out-of-pocket maximum to $904 from $881
  • Drug claims from your Quebec plan members are now subject to the new out-of-pocket maximum of $904.
Reduction in co-insurance (amount RAMQ pays) to 70% from 71%
  • Drug claims that were previously paid at 71% to comply with RAMQ’s minimum requirements are now paid at 70%.
  • If your plan supplements RAMQ coverage for plan members age 65 and over, you can expect a slight increase in claim costs for these members because the portion reimbursed by RAMQ will decrease by 1%.

We updated our systems to reflect these changes. There will be no immediate rate adjustments due to these changes and we expect that the impact on claim experience will be minimal.

Please refer to Focus Update # 121 for more information.

QUEBEC
New Quebec Drug Policy may affect group benefits plans
The Quebec Health Ministry announced in February 2007 that it was implementing the Quebec Drug Policy. To be phased in over a three-year period, the policy focuses on:

  • Access to drugs
  • Fair and reasonable prices for drug therapies
  • Optimum drug use
  • Maintaining a thriving pharmaceutical industry in Quebec

Removal of drug manufacturer price freeze
First on the agenda is to remove a drug manufacturer price freeze that has been in force since 1994. Manufacturers can now increase the price of formulary drugs each April by as much as the Consumer Price Index (CPI) for that year. Higher increases may be authorized in rare cases, but any excess cost over the CPI will be billed to the patient, not the provincial drug plan.

Because Quebec’s drug price list has been considered the benchmark for other provinces, this price freeze removal will likely affect drug prices in other provinces. That in turn could have an impact on private plan costs.

The pricing structure in Quebec
In Quebec, the agreement between the Association des Pharmaciens Propriétaires du Québec and third-party payors such as Emergis allows payment for a usual and customary price. The price submitted by a Quebec pharmacist includes the manufacturer ingredient cost, a usual and customary mark-up, and a usual and customary dispensing fee.

While the ingredient cost had been frozen since 1994, the mark-up and the dispensing fee have increased over the years in reaction to market trends and to keep up with the inflation rate. This may help explain why we have observed price increases in Quebec over the years in spite of the manufacturer price freeze.

Other Drug Policy resolutions that may affect plan costs:

  • New life-saving drugs will be fast-tracked for addition to the provincial formulary. By law, drugs listed under the provincial plan must be covered by the private plan.
  • Generic pricing will be decreased (to 60% / 54% of the brand name price.) The cost of generics in Quebec was previously 70% and 63% for the respective first and second generics listed on the provincial formulary.
  • Wholesaler mark-ups were lowered to 7% from 9%, thereby lowering the pharmacist’s acquisition cost.
  • Professional allowances will be limited to 20% of purchases.
  • Patients will be allowed to purchase selected drug therapies in the community setting and bring the drug for administration in a hospital setting.

At this point it’s too soon to predict the impact Quebec’s Drug Policy will have on our drug plans. We’ll continue to monitor the impact of these changes.

NOVA SCOTIA
Nova Scotia to eliminate mandatory retirement
Nova Scotia’s Bill 163, An Act Respecting the Elimination of Mandatory Retirement, takes effect July 1, 2009. This two-year window gives employers time to prepare (e.g. negotiate collective agreements) for changes to the various pieces of legislation affected by Bill 163. Among the changes, a revised provincial Human Rights Act will prohibit employers from forcing mandatory retirement at age 65.

Bill 163 adds a bona fide occupational requirement exclusion. This means that certain jobs such as firefighters and pilots may justifiably have a mandatory retirement age if a worker’s age could significantly affect his or her ability to do the job. Exclusions must be approved by the Human Rights Commission.

The legislation won’t affect eligibility for retirement under pension plans.

Impact on your plan
Though we don’t see any necessary contract changes resulting from the legislation, you may want to seek advice to ensure you understand the full impact of these changes on all of your human resources practices.

If you want to provide coverage for plan members over 65
With the exception of Long Term Disability, which terminates at 65, we can offer the option to continue benefits beyond age 65. Generally, Extended Health Care and Dental can be offered to the earlier of age 70 or retirement. Life and Accidental Death & Dismemberment coverage also extends to age 70. Some exceptions to these standards may be available.

We will continue to review our product portfolio to ensure we’re able to meet the needs of plan members staying in the workforce beyond age 65.

For more information, refer to Focus Update # 117 or go to Bill 163.

NEWFOUNDLAND AND LABRADOR
Newfoundland and Labrador add new component to Prescription Drug Program
Newfoundland and Labrador has added a new component to its provincial drug program. Effective October 31, 2007, the Assurance Plan caps out-of-pocket costs for eligible drugs based on a family’s net income. The lower a family’s income, the lower the percentage of income they have to spend on eligible drugs.

Legislative change

Maximum percentage of income to spend on eligible drug costs

$0 - $39,999

5%

$40,000 - $74,000 7.5%
$75,000 - $149,000

10%

We don’t have enough information at this point to assess what impact this will have on our drug plans.

For more information on the Assurance Plan and the other components of the Newfoundland and Labrador Prescription Drug Program, go to Assurance Plan.

For more legislative news
You can find more information on these and other legislation-related issues in Focus on legislation in 2007 in the Focus Update archives at Focus Update 2007. If you have any questions, please contact your Sun Life Financial Group Benefits representative.