News 9/22/2020

BenefitsPro: How Employers Can Support Smart Employee Benefits Choices During the Pandemic

Due to the COVID-19 pandemic, employers are paying attention to health care coverage more than ever. In fact, a recent LIMRA survey report found that 40% of employers say the coronavirus outbreak has affected their views of the importance of health care benefits. In a world where it feels like health is out of the individual’s control, they understand that employees want to, at the very least, secure control over their coverage.

Employers need to play an even larger role in making their employees feel as supported as possible when it comes to their health care coverage – starting with ensuring they are equipped with, and understand, the information they need to make smart health care choices for themselves and their families.

Given the current state of uncertainty in health care and the world at large, there is a lot to consider when communicating with employees about their benefits. Here are a few pandemic-specific changes to keep in mind to help employees act as informed health care consumers as COVID-19 continues to unfold.

Planning for postponed elective procedures

Many employees (or their family members) have postponed or forgone elective procedures, either because they want to reduce exposure to COVID-19 at hospitals or because their communities have issued orders to delay elective care in order to focus resources on the pandemic.

One global study estimated that 28.4 million elective surgeries worldwide could be canceled or postponed in 2020 due to the virus. As employers prepare their benefits communications for 2021, they must consider the impact of this trend. Anticipating a marked increase in elective procedures once hospitals reopen, employers should encourage employees to explore their options and shop for the best price. A second opinion may be in order, if the patient’s condition stabilized, improved or worsened during the delay; there may be other treatment options available.

It’s also possible that some providers will ratchet up prices to compensate for what they lost during COVID-19, so employees should always research several options before scheduling an elective procedure, particularly if they are going out-of-network or are enrolled in a plan without a network. Most important, employers will want to emphasize how employees can get preventive care and elective procedures in the safest way possible to avoid financial and health impacts later on.

Anticipating the aftereffects of COVID-19

Employers must also anticipate the ripple effect of employees being quarantined and not having easy access to doctors, preventive care and vaccines. For instance, many children will have missed their pre-school vaccinations. As a result, there may be an uptick in measles, mumps and rubella. If school is conducted virtually, the risk of catching one of these highly contagious diseases is somewhat reduced, but employers and health care providers should prepare for a surge regardless as states reopen.

As there are continued waves of COVID-19 this summer and into the fall, health care consumers and their children may have to wait even longer to get vaccinations. In this case, employers should encourage their employees to consider other venues for receiving vaccinations beyond the doctor’s office, such as pharmacies and retail clinics.

Furthermore, employers will need to consider the long-term implications of COVID-19. Research suggests that there are serious health impacts that emerge in survivors of COVID-19, such as the onset of diabetes and liver, heart and lung problems. Employers need to prepare for the impact of these aftereffects and the potential short- and long-term uptick in serious health issues amongst employees who had the virus. They should also develop communications to employees about these specific risks and how their benefits can be used to cover care.

Addressing hospital closings and network changes

Many hospitals are facing financial challenges during the pandemic, with the American Hospital Association estimating $202.6 billion in losses for America’s hospitals and health systems between March and June alone. Many small hospitals are closing as a result, with 10 already shutting their doors this year.

In addition to some closings, large hospitals are continuing to purchase smaller, independent medical practices. This trend was already prevalent pre-COVID-19 but may increase as smaller practices become more financially vulnerable due to the pandemic. In response, employers should encourage employees to perform a “checkup” of their coverage during open enrollment–for example, an HMO or EPO may not make sense if the employee’s preferred in-network providers are no longer available. Employees should do the same exercise with their providers–especially those they might not see regularly–making sure they are still in business and still in network (if applicable).

These hospital closings and acquisitions could not only shift networks but also impact the pricing of care. With fewer options available, there will be less competition between hospitals and, therefore, less incentive to heavily discount services to a carrier. As a result, employers should expect to see some price increases at the hospitals still open–predominantly in rural areas. Fortunately, there is a new regulation that requires hospitals to post their pricing publicly, which should discourage dramatic price jacking.

That said, employees based in rural areas may be left without their doctors and will likely have to travel farther to reach in-network facilities. In turn, it may be harder for employers to find a network that covers a majority of employees, and as a result, companies will have to cover more out-of-network services where an in-network provider isn’t located nearby.

It’s important for employees to be aware of these changes so they understand the impact not only on their care options, but also on their wallets. According to a Kaiser Family Foundation survey, nearly 7 in 10 individuals with unaffordable out-of-network medical bills did not know the health care provider was not in their plan’s network when they received care. Specific to the pandemic, employees need to keep an eye out for unexpected costs related to COVID-19 testing and treatment, given many individuals were under the impression they would be completely covered.

Employers should consider investing in advocacy and transparency services, so employees have the resources they need to find new providers (if necessary) and compare costs across different options and providers. Advocates can also help with unexpected COVID-19 costs, as they can communicate what employees’ plans do and don’t cover, and direct employees to where they can get information about their state’s testing requirements. If employers invest in these services, they should highlight their availability alongside other forms of pandemic support, such as telemedicine services, an Employee Assistance Program (EAP), temporary (or permanent) plan changes made to address COVID-19 concerns, and the any steps the employer is taking to protect employee health and safety when they return to the workplace.

Focusing on the immediate future

It is vitally important that employees understand their benefits options so they can get the best care for themselves and their families during this critical time. Employers should consider bringing benefits educators on board to help employees make more thoughtful health care decisions–and truly understand all that is available to them. Benefits educators can have one-on-one conversations with employees about their specific health care needs, helping to cut through the noise and high volume of health care information being disseminated during the pandemic.

Remember that traditional channels for benefits education may no longer be effective with so many employees working from home. Explore hosting virtual benefits fairs and offering telephonic enrollment support, as well as other forms of electronic media (including social platforms). Having the support of benefits educators, advocates and transparency services can make all the difference in employees making smart health care decisions, saving themselves and their employer’s money on health care.

Read the article here.

Kim Buckey is vice president of client services at DirectPath.

2020 Consumer Report: The Health Care Literacy Gap Why Personalized Benefits Education is the Key to Cost Saving
2020 Consumer Report: The Health Care Literacy Gap Why Personalized Benefits Education is the Key to Cost Saving
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