As COVID-19 continues to put workers at risk, the effort to stop—or slow down—the coronavirus is leading states, insurance providers and employers to waive health costs.
California, Colorado, Maryland, New York, Vermont and Washington have already directed insurance providers in their respective states to halt co-pays associated with coronavirus testing, and some have issued similar calls for treatment as well. Several private insurance companies in other areas of the United States have already ceased costs for testing, but not for treatment of the virus, says America’s Health Insurance Plans (AHIP). It’s worth noting that the federal government currently has no authority over insurers; instead, it is up to the states to regulate providers.
“As the Centers for Medicare & Medicaid Services has reported, many states are encouraging their issuers to cover a variety of COVID-19 related services, including testing and treatment, without cost-sharing, while several states have announced that health plans in the state must cover the diagnostic testing of COVID-19 without cost-sharing and waive any prior authorization requirements for such testing,” says Kim Buckey, vice president of Client Services at DirectPath. “Obviously that relieves a great deal of financial pressure on both employees and employers.”
While employees under fully insured plans will be able to get tested for free under these states and providers, millions of uninsured Americans and those covered by self-insured plans will still have to find ways to afford co-pay costs. Current regulation by most insurance providers and states allows for self-insured plans to opt out of the program, meaning these employers may not choose to cover co-payments.
Companies that typically self-insure will pay their employee’s medical bills directly and select their own benefits. While these plans will hire an insurer to manage the plan, these providers are not allowed to change benefits without the employer’s approval. Therefore, employers have full say when it comes to these plans.
According to the Kaiser Family Foundation, 61% of American workers are currently covered under self-insured plans. Unless an employer decides to independently cover co-pays for testing and/or treatment, these workers are left to foot the bill themselves, or worse, forgo testing and treatment. To avoid these situations, Julie Stone, managing director of the Health & Benefits team at Willis Towers Watson, urges employers to waive the costs or divert from opting out of an insurance provider’s program. “There is only an upside when it comes to an employer waiving costs and co-pays. The best thing from a public health and employer perspective is to have the access to testing,” she says.
For employers worried about paying more, Stone encourages plan sponsors to look at the situation as a short-term cost for a long-term investment, even if it’s tough to do so. Employees who are sick can take time off and recover without worrying about payments, surprise bills or spreading the virus to coworkers. “While not opting out can increase their costs, the net return by early testing and having those who test positive out of the workforce could actually save them money,” she explains. “Rather than employees not getting tested and potentially spreading the virus to others.”
Buckey agrees, explaining how providing costs for testing can help stave off high-cost claims for health benefits in the long run if people get treated early. “As we know, most patients with COVID-19 experience minimal to moderate symptoms and can be treated at home; doing so frees up important hospital resources for the truly ill,” she explains. “Those who test positive and know they are at risk for complications, such as the elderly, immune-compromised, etc., can talk to their doctors or other medical professionals about getting treatment and whether they should be hospitalized.”
Employers with self-funded plans who plan on taking action can meet with their brokers, insurers and stop-loss carriers to plan for what they are willing to cover, with respect to out-of-network bills for treatment, Buckey adds. Additionally, she mentions that now is a good time to communicate with employees about their options and what the employer is doing for them.
“In the meantime, employers should consider adding telemedicine services, if they do not already offer them, and be communicating frequently and consistently about what employees should be doing to protect their health, what the employer is doing to support their health, what their plans do and do not cover, and what other programs may be in place to assist,” she says.
Looking forward, providing assistance during these stressful times can increase a worker’s financial—and overall—wellness. Employees can focus on their health instead of anxiety, thus leading them to be happier, healthier and even more productive workers.
“One of the things I’m seeing now is the importance of employers clearly communicating,” Stone concludes. “Employees need to understand what their employers are doing for them and knowing this will have a long-term impact on their employee reaction, and retention.”
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