Top 4 Employee COVID-19 Benefits Coverage Questions

While the number of COVID-19 cases appears to be plateauing in much of the country, employees continue to have more questions and concerns about their health benefits and coverage than ever.

With employees looking to their employers as a source of current, accurate information, HR teams have been inundated with requests from concerned employees. Unfortunately, most HR teams don’t have the bandwidth to monitor the changing regulations, sort through conflicting information, and respond to inquiries on a timely basis.

To help, we pulled together the top questions employees are asking in relation to COVID-19 so you can proactively engage your employees with the information they need.

How Does Our Benefit Plan Cover COVID-19?

Recent legislation has dictated cost-sharing requirements for virus testing, antibody testing, treatment, vaccine, and balance billing—and outlined specific provisions affecting health savings account (HSA)-eligible high deductible health plans (HDHPs). However, employers must proactively “opt in” to many of these guidelines, and others assume employees are seeing in-network providers. Here’s what employees need to know:

Testing. Coronavirus testing—and any visit to a doctor’s office, an urgent care clinic, or the emergency room (ER) that results in an order for the test or the test itself—is free of charge to all U.S. healthcare consumers. This holds true regardless of whether individuals have insurance or the type of insurance they have. Patients should not be billed (or subject to preauthorization) as long as:

• They were tested after March 18, the date the law was signed.
• Their visit actually resulted in a COVID-19 test (i.e., the doctor determined a test was advisable).
• They get tested by a doctor or facility that is in their plan’s network (if a network applies).
• They do not receive any type of treatment—whether or not related to COVID-19.

If a patient gets tested at an out-of-network provider, your plans will reimburse the facility or provider at the “cash” price the provider has posted on its public website, unless the plan has negotiated an out-of-network rate with that provider.

Antibody testing—once available—must also be covered at no charge.

Note that the cost-sharing waiver for testing is set to expire on June 16, unless the cutoff date is extended by the administration.

Treatment. Currently, your employees will be subject to the usual deductibles, copays, and/or coinsurance if they need treatment for COVID-19. The final cost will depend on the type and level of care they receive. While some insurance companies are waiving cost sharing (e.g., copays, coinsurance) for COVID-19 treatment, this is not true of all insurers, and employers generally must opt in to the waiver. And even if employers decide to waive costs moving forward, it may not apply to treatment that has already happened or is underway.

While the new regulations permit HSA-eligible HDHPs to cover treatment on a first-dollar basis—and without negating the employee’s ability to contribute to the HSA—this is an optional coverage change up to the employer to adopt.

Vaccines. Once a vaccine becomes available, it must be covered as preventive care within 15 business days after it receives an “A” or a “B” rating from the U.S. Preventive Services Task Force (USPSTF) or a recommendation by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention.

HDHPs. In addition to the first-dollar coverage of treatment costs described above, HSA-eligible plans may also cover telehealth services on a predeductible basis—even if the visit is not related to COVID-19. This change to cost sharing is permitted from March 27 through December 31, 2021. Again, this is a change an employer must proactively adopt.

Balance Billing (aka Surprise Bills). The government recently announced that hospitals that accept stimulus funding would be prohibited from balance billing (aka, charging out-of-network patients the difference between the provider’s usual charge and what the employee’s insurer will pay)—whether or not a patient actually tested positive for COVID-19.

However, it’s unclear how the administration would track such billing to hold hospitals and health systems accountable. It’s likely we’ll see further legislation on this in the weeks and months ahead.

How Can I Get The Most from My Health Insurance if I or a Family Member Needs Treatment?

The first step is understanding what’s covered and how. Encourage employees to call the member services number on the back of their insurance ID card; read their summary plan description (SPD); or log into their insurance carrier’s member website if the HR team is not available for questions.

Individuals experiencing symptoms should contact their doctor or local health department to determine the best course of treatment. That one phone call can mean the difference between treating at home with over-the-counter medications or a possibly unnecessary (and risky) ER visit. If your plans are providing free or reduced-cost telemedicine visits, promote this to your workforce.

If plan participants do require hospital treatment for COVID-19, remember there is no set cost for health care. Expenses may depend on which hospital they go to; whether the facility is in network or out of network; whether the caregivers who treat them are in network; and, of course, the severity of their condition.

Encourage your employees (or family members) to keep track of the following information:

• Which doctors they see and when
• What treatments and medications they receive
• How long they are in each treatment area (e.g., 5 hours in the ER, a week in the intensive care unit, 2 weeks in a standard hospital room)

Remind employees to ask for an itemized bill when they are discharged. Cross-referencing their notes against the bill will ensure they aren’t overcharged for the treatment they need.

Will Health Coverage Continue After I Lose My Job?

It depends on your (the employer’s) situation.

Furloughs are essentially unpaid leaves of absence, so your plan document will spell out when coverage will end (likely the date the furlough occurs or at the end of that month). You may be able to negotiate with your carrier or stop-loss insurer to extend coverage for some period of time; if not, you must offer Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage.

You may want to remind employees that they may also be able to purchase coverage through the Affordable Care Act (ACA) Marketplace (or their state’s equivalent), Medicaid, and/or the Children’s Health Insurance Program (CHIP).

Employees whose hours are reduced or who are laid off can apply for COBRA; purchase individual coverage (either independently or through the state or federal marketplace); apply for Medicaid and/or CHIP; or, if over age 65, apply for Medicare.

If workers lose their job because you are ceasing operations, those affected individuals can apply for individual, marketplace, Medicaid/CHIP, or Medicare coverage, as applicable.

This Is Making Me Really Anxious and Depressed. What Can I Do?

Again, your workforce is looking to you for recommendations and direction. Let your employees know what resources are available to them, either through the company or their community. If you offer an employee assistance program (EAP), make sure to promote the phone number and website.

You may also want to remind employees of how the plan covers behavioral health in general in case they need longer-term support. And let them know if the plan covers telehealth appointments for behavioral health concerns. You may also suggest that employees:

• Limit their media exposure. While it’s important to stay informed about changing events involving COVID-19, taking a break from the news coverage can help reduce stress.
• Stay in touch with friends and family. Make phone calls, use video chats, and maybe even write notes and letters.
• Practice self-care—whether it’s watching a favorite movie, reading the latest best-seller, or trying out a new exercise program.
• Get some fresh air. Take a walk outside, or visit a park—just keep 6 feet away from others.
• Ask for help if they need it.

These questions and answers only scratch the surface of the COVID-19 quandary. As employees are inundated with more information, they are turning to their trusted source: their employers. HR departments and benefits professionals must develop a strategy that communicates updates to their employees frequently and accurately so individuals can make smart, cost-effective healthcare decisions during this time.

Kim Buckey is DirectPath’s key advisor and senior subject matter expert on new and evolving compliance issues that affect employers as a result of the Affordable Care Act. Kim, who founded and directs the DirectPath compliance communications team, works closely with sales, explores the potential impact on customer segments to develop new products and services to support current and anticipated needs. Kim has more than 40 years of communications experience, 35 of which focus on the delivery of compliance communications for health/welfare and qualified (savings/pensions) plans. Kim’s team provides strategy, review and analysis, content development and management services for employers, providing guidance on new mandates like the required Summary of Benefits and Coverage (SBC) and the growing trend of Medicare Advantage and its required compliance documents.

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