Penalizing the Unvaccinated

boosterWhile some employers are considering surcharging employees who remain unvaccinated for Covid-19, Nevada recently became the first state to act when it said a $55 monthly penalty would take effect in July of 2022. The penalty will apply to state workers and adult dependents to offset the cost of weekly testing. Consultants caution that adding a premium penalty could cause employees to seek coverage on the exchange, exposing employers to costly penalties under the ACA.


More Resignations


With Covid-19 having changed the way millions of people work and a huge number of job openings still unfilled, many workers are weighing their options. In a June survey by search company Monster, 32% of respondents said they would consider a change to escape the burnout experienced in the past year. Burnout was an even greater concern in research by employee experience software company Limeade. Monster Worldwide lists flexibility, remote work options and mental health as keys to retaining people in an over- heated job market.


Booster Shots Begin

boosterWhile initial recommendations from the Centers for Disease Control and Prevention were somewhat confusing, the Covid-19 vaccine from Pfizer and BioNTech SE are now being administered to adults 65 and over and others who are 12 years and older with weakened immune systems.

The Moderna Inc. vaccine booster was also recommended for those who are immunocompromised and 18 years and older. CDC officials said that those who are eligible would not require any documentation or prescriptions and could receive the booster from their physician or at any site where vaccines are administered. The FDA said other fully vaccinated individuals are sufficiently protected and don’t need an additional dose of a Covid-19 vaccine.


Responding to Vaccine Mandates

vaccine-mandateWhen the White House released its COVID-19 Action Plan on September 10th, it placed a great deal of pressure on employers of 100 or more. In the weeks that have followed, OSHA has worked on rules while some public entities around the country have been preparing lawsuits. The OSHA emergency rule could affect as many as 80 million Americans and will require large employers to provide paid time off for workers not only to get vaccinated but to recover from any negative side effects relating to the vaccine. Failure to comply could result in fines up to $14,000 per employee.

Reasonable Accommodations

The HIPAA Journal points out that while employers are within their rights to terminate employees for refusing vaccination, EEOC requires that reasonable accommodations be made in accordance with state laws if a genuine medical or religious exemption exists. Weekly testing will be required for those who cannot be vaccinated and because these tests will not be paid for by the government, employers will need to determine if employees will have to bear the entire cost or if some form of cost sharing can be provided.

Record Keeping

Even though details of government requirements are still forthcoming, companies with 100 or more employees should begin tracking immunizations and weekly testing as soon as possible. Vaccinated individuals should be able to access their immunization records from the provider or pharmacy that administered the vaccine. Your recordkeeping should allow for updates as some decide to get vaccinated or perhaps as others receive a second Pfizer or Moderna dose.

OSHA is expected to issue a temporary emergency standard for reporting of immunizations and testing and the CDC website should provide up to date information. Getting the information needed to meet reporting requirements will require everyone’s help and understanding. Employers are advised to communicate your compliance strategy to employees in writing and to make every effort to make it as easy and convenient as possible for employees to find answers to important questions.


Quality Health Benefits Can Be Affordable

health-benefitsLast Fall, COVID-19 was weighing so heavily on our minds that simply keeping health benefits available during the Pandemic was the top priority. Today, with many people needing medical care they may have postponed and pressure to maintain sufficient staffing, keeping your health plan both effective and affordable is a must.

The fact is that after a year unlike any other, your organization needs to huddle with its broker/advisor and TPA to do all it can to fight back against rising healthcare costs. Remember that your organization transitioned to self-funding to take control of rising costs and gain the flexibility needed to compete successfully in a rapidly changing world. So, with 2022 right around the corner, let’s revisit a few steps that could keep your organization on the path to high quality, affordable healthcare.

Question Everything – For self-funded employer groups, there are no off the shelf plan designs. When a plan year was successful, we want our clients to know what made the difference. If claims were higher than expected, we help you understand where your healthcare dollars went and what your plan can do to bend the curve.

Be a Disruptor – Annual rate increases of 5 to 7 percent should never be accepted as being par for the course. Solutions to rising costs are in your claims data and the right advisors can help you explore new options. Carve-outs for Specialty Pharmacy and Referenced Based Pricing are just two of the ways we’re helping health plans achieve significant savings.

Blocking & Tackling – Monitoring claims and utilization data day in and day out takes industry-leading technology and skilled claims analysts. Digging deeper into claims will help your plan uncover billing errors and find hidden revenue in your health plan.

Communicate, Educate, Advocate – Because managing the cost and quality of employee healthcare is a year-round responsibility, we do our best to keep employers, plan members and broker advisors informed and supported throughout the year. This is especially critical given the costs associated with chronic healthcare conditions and the rising frequency of high-dollar claims.

These measures may not be new, but when implemented consistently, they will produce significant savings, not only for your health plan but also for the members your business depends on.


Telehealth Slows

sip-telehealthAccording to a survey of healthcare professionals by Klas Research, telehealth visits have leveled off at about 20% of all healthcare appointments. While telehealth services are still used frequently for primary care and behavioral health, the percentage of telehealth visits is considerably lower than it was during the early phase of Covid-19.


More Women Avoided Care

health-blogThe Kaiser Family Foundation reports that more women than men failed to receive preventive care during the pandemic. Statistics show that 38% of women skipped their annual checkup compared to 26% of men and nearly one in four women failed to get a recommended medical test or treatment versus only 15% of men. Income did not appear to be a big factor, leading consultants to believe that fear of exposure to Covid-19 and the inability to access medical facilities were big contributing factors.


What the Pandemic Has Taught Us

pandemicWhether you’re a TPA, broker, employer, plan member or healthcare provider, the past year has been unlike any other. While adapting has often been difficult, some of the lessons learned can have a positive impact on employee healthcare in the future. Here are a few to consider as you begin your planning for the coming year.

Open Enrollment

According to the IFEBP, 1 in 5 companies handled open enrollment differently in 2020, with many using virtual benefit events. Virtual benefits meetings can be viewed by members from any location at any time. In addition, members can easily share their benefits information with a spouse or family member, something that cannot be done with traditional in-person events. Many used short video introductions and important details were typically made available on secure online employee portals following the virtual event. Offering a dedicated email address, phone line or online chat option can make it easy for members to ask questions.


Think for a moment that Cleveland Clinic delivered 1.2 million virtual physician visits in 2020, compared to just 37,000 in 2019. Even after resuming in-person appointments, 30% to 40% of all visits at Stanford Health Care are virtual and while physicians and patients say there is certainly room for improvement, nearly 3 of 4 patients say they are likely to choose a video consult over in-person in the future. While many physicians say they would prefer to use telehealth visits to manage chronic diseases, many cite low or no reimbursement and technology challenges on the part of their patients as the biggest obstacles to its continued use.

Health Benefit Value

One challenge that remains even as the threat of Covid-19 lessens is the rising costs facing employer-sponsored health plans. Research from the Kaiser Family Foundation and The Hartford show a decline in the perceived value of health benefits by plan sponsors and members. These trends can only change as personal service improves and the barriers standing in the way of healthcare cost transparency are overcome.

As an independent TPA, we place the needs of your health plan and members first by providing personalized service and striving to eliminate costly conflicts of interest that have plagued our healthcare system.