As you begin planning next year’s health & welfare strategy in these unprecedented times, we want to provide you with some critical questions and discussion topics we believe HR teams should be addressing with their brokers, consultants, and health & welfare carriers.

Self-Insured Medical Cost Impact

• What adjustments will be made to the standard budget underwriting methodology to account for the impact of COVID-19?
  • How will costs for non-acute, non-COVID-19 related care be accounted for (i.e., if members did not seek certain
    types of care during stay-at-home orders, do we expect they will once restrictions are eliminated)?
  • For those who tested positive for COVID-19, will additional costs be added to the claims to account for potential
    ongoing impact to the members’ health (lungs, heart, mental health, etc.)
  • Should additional margin be added to account for a potential second wave?
  • Could there be an increase in catastrophic claims due to a delay in diagnostic testing / early disease detection?
  • Should the cost of the impending vaccination be built into 2021 projections?
  • Will costs for standard PCP visits be suppressed as more employees turn to telemedicine?
  • In the short-term, what should I expect the impact to be on my Rx spend?
  • Should stop-loss levels be adjusted? Should aggregate coverage be considered?
  • Should credibility for the current year’s claims (or certain months) be adjusted?
  • How will IBNR be adjusted?

Benefit Considerations

• Should I request a rate pass / rate reduction on our next fully-insured dental / vision renewal due to several months of minimal utilization?
• Should I take advantage of the recent uptick in telemedicine / telehealth utilization and legislative changes to expand our telemedicine / telehealth offerings beyond the traditional solutions?
• How can I ensure that those who may have missed a key diagnostic test or preventive service re-schedule those appointments?
• How can I ensure that drug adherence and dosage amounts have not been negatively impacted?
• It has been observed that in severe COVID-19 cases, individuals may have lingering heart and lung issues. What point solutions should I consider to help with potential ramifications of COVID-19 (e.g., care management, robust telehealth, care navigation, mental health, etc.)
• Should I look to partner with a vendor for COVID-19 testing?
• Should I change anything within my plan due to recent / potential upcoming legislative changes?
• Should I assess my disability plans for coverage during a quarantine?
• If employees are still working remotely as we approach our renewal, how can I best deliver open enrollment communications?