Experts say clients concerned about renewal process that will hinge on flexibility in plans, care options
COVID-19 has crept into virtually all aspects of the business world, including employee benefits. Employers, employees and insurers were faced with some tough questions, and uncertainty still looms to a large extent.
With open enrollment approaching, experts say companies must think outside the box to make more informed decisions and avoid getting blindsided.
Mike Telesky, vice president of key account sales and account management at UnitedHealthcare, said there were a few common themes in their conversations with employers in recent months. Choice is one that comes to mind.
“We really want to make sure there’s a broad variety of (choices) in plan design for employees, whether it’s taking advantage of high-performing networks that are in the marketplace that could allow more first-dollar coverage for family members and employees, so that could be a high-performance network with a very rich plan design,” Telesky said. “So it comes at a competitive price point for them but reduces the member cost.”
There also has been interest in health savings account plans, which are employee-owned and allow members to accumulate funds that roll over annually.
Telesky speaks from the insurer perspective, while Ray Korson has a different view. He’s principal and practice leader with the employee benefits group at Gibson Insurance in South Bend, serving as a liaison between the employer and insurers.
Korson said the pandemic disrupted his industry, and at the same time, challenged his team to think differently.
“My role is to make sure that the value proposition that we are currently on at Gibson is evolving appropriately to meet the demands of our clients as things change over time,” he said. “I work very closely with our operations team as well to make sure that any new elements to our value proposition that we’re building out get implemented.”
Korson said he and his team organized processes around open enrollment to ensure the right people were in place to deliver the best client experience.
For instance, he said Gibson staffers took a step back to evaluate their role as a trusted consultant and subject-matter expert. In the past, it was common practice to automate some aspects of open enrollment, but now is not the time for a hands-off approach.
“If anything, we saw a lot of clients that really fell back on us for a lot of support that they wouldn’t have gotten elsewhere necessarily, and in a lot of cases, they looked to us for expertise and guidance during these times as they were responding to this coronavirus crisis.”
As far as response, Korson said clients were more willing to flex their eligibility for their plans and make sure employees did not go without health insurance or benefits coverage. In some cases, this meant clients had to reduce workforce hours or put workers on furlough for a fixed amount of time or an indefinite amount of time, because they wanted to do what was right by their employees.
“By and large, companies were very willing to support their employees during these challenging times,” Korson said.
Insurers also stepped up their game.
“Most every insurance company will cover COVID-19-related spending,” said Eric Gibson, employee benefits adviser with General Insurance in Hobart. “A lot of those expenses are covered at 100%.”
He said part of the reason was governmental push, and the other part was insurance companies agreed to do it because it made sense. Telesky said UnitedHealthcare was among the providers that wanted to cover COVID-19 care costs.
“Part of our response to COVID-19 was to make sure that we’re waiving all member costs for the treatment of COVID-19 through July 24, 2020,” he said. “That’s across our fully insured commercial book of business, Medicare Advantage plans and our Medicaid plans.”
UnitedHealthcare and other insurance carriers stepped up as the situation worsened in the spring, but other concerns arose.
Gibson said employers expressed anxieties about the rising costs of health care and how the pandemic might affect the coverage itself. “That’s been the main thing now,” he said.
“Employers see everything going on, and they’re already scared about renewals coming up and the rising cost of health care, and they’re (saying), ‘Oh my God, if all of these people have to go to the hospital and be put on ventilators, what is that (going) do to us?’ The good news is we haven’t been seeing that happen.”
Gibson said claims have decreased, likely because elective surgeries were postponed as confirmed COVID-19 began rising.
“We do expect to see (some type) of rebound … you know … the folks that need to get their knee replaced or their shoulder worked on,” he said.
Elective surgical procedures might have been delayed by the pandemic, but at the same time, care providers and insurers have been innovative as they continue to serve clients and patients.
Turning to virtual technology
Korson said the crisis brought telemedicine to the forefront.
“That’s one of the programs that a lot of insurance companies have built that they were offering at low co-pays or low cost for employees to utilize, but participation in those sorts of programs were always pretty dismal,” he said.
Korson said employees were not always aware of the virtual offerings or did not trust them as an “adequate replacement for an in-person provider consult.”
Telesky said COVID-19 fueled increased usage of telemedicine among regular primary care physicians so they could continue to see patients.
“We’ve seen a significant increase in people accessing their primary care physician through telehealth that used to be done in person,” he said. “So many doctors’ offices and clinics have expanded their capabilities to be able to offer that, so they can continue to consult with their patients virtually versus in person.”
Korson said health care providers who did not use virtual services learned to quickly adapt.
He said Section 3701 of the CARES Act creates a temporary safe harbor allowing high-deductible health plans — including those with HSAs — to cover telehealth services and other remote care without cost to plan members before deductibles are met.
Candace Arvin, employee benefits adviser at General Insurance Services and Gibson’s colleague, said a silver lining from a reduction in claims ahead of renewals can help an employer’s bottom line. That’s because the number of annual claims is going to be calculated into the renewal costs.
Beyond dollars and cents, Korson said employers should think in pragmatic terms when it comes to open enrollment.
“What is your virtual enrollment strategy? Because you know, it’s not really on our minds whether or not there will be a second wave,” he said. “There will more likely be (another high rate of infection), since there’s no vaccine in sight, and the virus isn’t just gonna disappear into thin air; so just think about practically how you are going to capture enrollment decisions from your employees, if we are in this socially distant world again.”
Korson said COVID-19 represents a fork in the road regarding how employers handle paperwork.
“If you’re doing everything in person or via paper, now is an excellent time to start thinking about how you’re going to implement an electronic enrollment solution,” he said.
Arvin said a little foresight can go a long way in setting up a business for success when open enrollment comes around, and it is best to be proactive.
“As a business owner, typically you plan your business operations very strategically,” Arvin said. “You don’t only plan 90 days out of the year, and then wing it the rest of the time and hope everything goes well, (because) all too often in our line of work we see people are only thinking about it within that 90-day window before open enrollment, during open enrollment, and then it just goes away.”
Arvin said insurers want to manage a client’s benefit plans the same way their manage their businesses.
“(Our goal) is to get you the most effective coverages for the most efficient rates for (as) many people as possible,” she said. “Then we’re all going to be stronger and better and healthier and have more money in our pockets because of it.”